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Aetna Medicare Enhanced Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Plus (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 Enhanced Plus (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in District of Columbia. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced Plus (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 Enhanced Plus (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 Enhanced Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. 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 $7500.00 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 Enhanced Plus (HMO-POS) plan features an annual drug deductible of $615 before coverage begins. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply. Higher-tier medications are subject to coinsurance rather than flat copayments. You will pay a 24% coinsurance for Tier 3 preferred brand drugs at both preferred and standard pharmacies. For Tier 4 non-preferred drugs and Tier 5 specialty drugs, a 25% coinsurance applies across all pharmacy and mail-order options.
Additional Benefits
The Aetna Medicare Enhanced Plus (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits and copays ranging up to $30 for specialist appointments. Inpatient hospital stays require a daily copay for the first eight days, after which there is no copay, while emergency room visits carry a $115 copay that is waived if you are admitted. Outpatient services and preventive care are widely covered, with most preventive screenings and annual physicals requiring no copay or coinsurance. For ancillary care, the plan features no copay for routine vision exams, annual hearing evaluations, and preventive dental cleanings, alongside allowance benefits for eyewear and prescription hearing aids. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100. Additionally, members can access home health services with no copay and receive a $30 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Enhanced Plus (HMO-POS) covers inpatient acute and psychiatric hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $340 daily copay for days 1-8 and no copay for days 9 and beyond, while psychiatric stays require a $260 daily copay for days 1-8 and no copay for days 9-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Enhanced Plus (HMO-POS) plan are covered with no coinsurance, featuring a $0 to $340 copay for outpatient hospital services and a $340 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Enhanced Plus (HMO-POS) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Enhanced Plus (HMO-POS), featuring a $275 copay (no coinsurance) for ground ambulance services and a 20% coinsurance (no copay) for air ambulance services, with prior authorization required. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered in practice.
Emergency Services See details
Aetna Medicare Enhanced Plus (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent services are covered with no coinsurance and copays ranging from $115 to $275 up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Enhanced Plus (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $30 copay and no coinsurance. Therapy, mental health, and psychiatric services have copays ranging from $30 to $40 with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Enhanced Plus (HMO-POS), with most covered benefits—including annual physical exams, health education, and screenings—featuring no copay and no coinsurance. Kidney disease education requires no copay but has a 20% coinsurance, while chemotherapy wigs are covered up to $400 annually, and services like weight management, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Aetna Medicare Enhanced Plus (HMO-POS) partially covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced Plus (HMO-POS) with no deductible and no coinsurance, including eye exams with a $0 to $30 copay and routine annual exams with no copay. Covered eyewear, including contacts and eyeglasses, also features no copay and no coinsurance up to a $100 annual maximum benefit.
Dental Services See details
Aetna Medicare Enhanced Plus (HMO-POS) dental services are partially covered, featuring a $30 copay and no coinsurance for Medicare-covered care, and no copay and no coinsurance for preventive exams and cleanings. Covered comprehensive services have no copay and 20% to 50% coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aetna Medicare Enhanced Plus (HMO-POS) plan with no copay, though prior authorization is required. Covered Part B insulin drugs carry a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced Plus (HMO-POS) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced Plus (HMO-POS) with no copays and coinsurance ranging from no coinsurance up to 20% depending on the item. This benefit covers durable medical equipment, diabetic supplies, and prosthetics, all of which require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced Plus (HMO-POS) with prior authorization required. Diagnostic tests and procedures carry no coinsurance and a $0 to $100 copay, while lab services and outpatient X-rays feature no copay. Diagnostic radiological services require a copay starting at $0, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced Plus (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Enhanced Plus (HMO-POS) with no copay and no coinsurance, meaning some services are covered. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Plus (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced Plus (HMO-POS) partially covers other services with no copay and no coinsurance for annual wellness exams, screening mammographies, and over-the-counter (OTC) items up to $30 every three months. Acupuncture, meal benefits, and Dual Eligible SNPs are not covered under this plan.
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