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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeastern Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Premier (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $61.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Premier (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance, and preferred brand drugs have a 25% coinsurance.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays. You'll find coverage for emergency services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facilities. Many services, like routine eye exams, preventive care, and dental services have no copay, but some services like inpatient hospital stays and ambulance services do have copays and coinsurance. This plan also provides additional benefits such as transportation services, over-the-counter items with a quarterly allowance, and a meal benefit. The plan has a $325 copay for days 1-5 of inpatient hospital stays, and has a $110 copay for emergency services. Some services, like hearing aids and eyewear, have maximum annual benefits, and many services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $325, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (HMO-POS) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The Aetna Medicare Premier (HMO-POS) plan covers ambulance and transportation services. Ground ambulance services have a $200 copay, and air ambulance services have 20% coinsurance. Transportation services to plan-approved health-related locations are covered with no copay for up to 6 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Premier (HMO-POS) with a $110 copay, while urgently needed services have a $45 copay. Worldwide emergency services are also covered, with a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $200 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services have a $5 copay, Chiropractic Services have a $15 copay, Occupational Therapy Services have a $20 copay, Physician Specialist Services have a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional services like health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Kidney disease education services have a 20% coinsurance. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, and have a copay, while OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams have a copay of $0-$35, while routine eye exams have no copay. Contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay. The plan offers a combined maximum of $500 per year for all eyewear.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Medicare dental services have a $35 copay, and orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay, and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $255, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (HMO-POS) plan. The plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Aetna Medicare Premier (HMO-POS) covers over-the-counter (OTC) items with no copay, a maximum benefit of $75 every three months, and offers Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered. The plan also covers a meal benefit with no copay. Additional services such as annual wellness exams, screening mammography, gFOBT, and FIT are also covered with no copay.
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