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Aetna Medicare Prime Extra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Extra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Extra (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Extra (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maricopa County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Prime Extra (HMO) 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 Prime Extra (HMO).
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 Prime Extra (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $615.00 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 $3300.00 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 Prime Extra (HMO) plan offers enhanced alternative prescription drug coverage with an annual drug deductible of $615.00. After meeting this deductible, you will have no copay for Tier 1 preferred generic drugs filled at preferred pharmacies or through preferred mail order, though a $12.00 copay applies at standard pharmacies. For other tiers, the plan charges a 24% coinsurance for Tier 2 standard generics and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. These copayments and coinsurance rates remain in effect until your yearly out-of-pocket drug costs reach $2,100.00, after which you pay nothing for covered Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy can receive a reduced premium and pay $0.00 for Part D.
Additional Benefits
The Aetna Medicare Prime Extra (HMO) plan provides comprehensive healthcare coverage with no copay for primary care doctor visits and a $40 copay for specialists. If you require hospital care, inpatient stays carry a $275 daily copay for the first seven days, while outpatient hospital services range from no copay up to $250. Emergency room visits have a $150 copay, which is waived if you are admitted, and urgent care services require a $50 copay. In addition to medical care, the plan features valuable supplemental benefits including routine hearing, vision, and preventive dental services with no copay or coinsurance. You will receive up to $175 annually for eyewear and a $1,000 annual maximum benefit per ear for prescription hearing aids. Most preventive services and home health visits are also available at no cost to you, requiring no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Prime Extra (HMO), featuring a $275 daily copay for days 1 to 7 of acute stays and a $370 daily copay for days 1 to 5 of psychiatric stays, with no copays for subsequent days and no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Prime Extra (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Covered outpatient hospital services require a copay of $0 to $250, while observation services cost a $275 copay per stay and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Aetna Medicare Prime Extra (HMO) covers partial hospitalization benefits, though prior authorization is required. Covered services incur a copay of either $55.00 or $180.00, with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Prime Extra (HMO). Ground ambulance services require a $265 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Prime Extra (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services, urgent care, and transportation are covered up to a $250,000 maximum with no coinsurance and copays ranging from $150 to $265.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Prime Extra (HMO), with podiatry and routine chiropractic services not covered. Covered services range from primary care visits with no copay and no coinsurance to specialist visits for a $40 copay and no coinsurance, while telehealth services require a 20% coinsurance and a copay ranging from no copay to $50.
Preventive Services See details
Aetna Medicare Prime Extra (HMO) partially covers preventive services, providing most covered options like annual physicals, health education, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, the plan does not cover in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, or counseling.
Hearing Services See details
Aetna Medicare Prime Extra (HMO) partially covers hearing services with no copay and no coinsurance for routine hearing exams, fitting evaluations, and general prescription hearing aids, which feature a $1,000 annual maximum benefit per ear. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Prime Extra (HMO) with no copay or coinsurance, including one routine eye exam per year and unlimited follow-up diabetic eye exams. Eyewear, including contact lenses, eyeglasses, and upgrades, is also covered with no copay or coinsurance up to a combined maximum benefit of $175 annually.
Dental Services See details
Aetna Medicare Prime Extra (HMO) partially covers dental services, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Preventive services like cleanings and exams have no copay and no coinsurance, Medicare-covered dental has a $40 copay and no coinsurance, and covered comprehensive services require a 20% to 50% coinsurance and no copay up to a $2,000 annual limit.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Aetna Medicare Prime Extra (HMO) with prior authorization, requiring a $35 copay and no coinsurance for Medicare Part B insulin. Other Part B chemotherapy, radiation, and miscellaneous drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Prime Extra (HMO) covers dialysis services with 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered under Aetna Medicare Prime Extra (HMO) with no copays across all services. Durable medical equipment, medical supplies, and diabetic supplies require no coinsurance to 20% coinsurance, prosthetic devices carry a 20% coinsurance, and diabetic therapeutic shoes and inserts are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Prime Extra (HMO), with prior authorization required. Diagnostic tests, lab services, and outpatient X-rays have no copay, while diagnostic radiological services range from no copay up to $190, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Prime Extra (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Prime Extra (HMO), meaning there is no copay or coinsurance coverage for these therapies. This lack of coverage applies to all associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Prime Extra (HMO), which requires prior authorization but does not cover additional days beyond Medicare-covered limits. There is no coinsurance for these services, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Aetna Medicare Prime Extra (HMO) partially covers Other Services, offering covered options like annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, meal benefits, and Dual Eligible SNPs are not covered.
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