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Aetna Medicare Signature Advantage (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature Advantage (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature Advantage (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Advantage (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Puget Sound Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature Advantage (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 Signature Advantage (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 Signature Advantage (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 $6750.00 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 Signature Advantage (HMO) plan features an annual prescription drug deductible of $615. 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 choose standard pharmacies or standard mail-order options, Tier 1 drugs carry a copay starting at $2.00, while Tier 2 drugs start at a $12.00 copay for a one-month supply. For higher-tier prescriptions, cost-sharing transitions to coinsurance across all pharmacy and mail-order options. You will pay a 24% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance and are covered for a one-month supply.
Additional Benefits
The Aetna Medicare Signature Advantage (HMO) plan offers comprehensive healthcare coverage with no copay for primary care doctor visits and low copays ranging from $0 to $60 for specialist consultations. For hospital care, members pay a $485 daily copay for the first five days of acute inpatient stays and no copay starting on day six, while outpatient surgical center services are also covered with no copay. Emergency medical services require a $130 copay, which is waived if you are admitted to the hospital. Routine vision, hearing, and preventive dental care are highly accessible with no copays, alongside covered home health services. For specialized needs, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance. It is important to note that this plan does not cover certain benefits, including routine transportation, cardiac rehabilitation, and over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Signature Advantage (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, you pay a $485 daily copay for days 1-5 and no copay for day 6 and beyond, whereas psychiatric stays require a $465 daily copay for days 1-5 and no copay for days 6-90, excluding upgrades, non-Medicare stays, and additional psychiatric days.
Outpatient Services See details
Aetna Medicare Signature Advantage (HMO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $485, observation services require a $485 copay per stay, and outpatient substance abuse sessions carry a $45 copay, with prior authorization required for several services.
Partial Hospitalization See details
Aetna Medicare Signature Advantage (HMO) covers partial hospitalization services with a copay of $140 or $145 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Signature Advantage (HMO) covers ground ambulance services with a $300 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature Advantage (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $45 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Aetna Medicare Signature Advantage (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $60 copay and no coinsurance. Physical, occupational, and speech therapies require a $40 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by the Aetna Medicare Signature Advantage (HMO) plan, featuring an annual physical, diabetes training, and glaucoma screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, and while select supplemental benefits like health education and memory fitness have no copay or coinsurance, other services such as weight management and in-home support are not covered.
Hearing Services See details
Aetna Medicare Signature Advantage (HMO) covers routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear annually, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature Advantage (HMO) with no copayments and no coinsurance for annual routine eye exams and follow-up diabetic eye exams. Covered eyewear, including contact lenses and eyeglasses, also features no copay or coinsurance up to a combined maximum plan benefit of $100 per year.
Dental Services See details
Aetna Medicare Signature Advantage (HMO) partially covers dental services, providing Medicare-covered dental care for a $60 copay and no coinsurance, and select preventive services like exams, cleanings, and X-rays with no copay and no coinsurance. However, fluoride, restorative, endodontic, periodontic, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature Advantage (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Medicare Part B chemotherapy, radiation, and standard drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature Advantage (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Signature Advantage (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and coinsurance ranging from no coinsurance to 20%, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature Advantage (HMO) with prior authorization required. Lab services and outpatient X-rays feature no copay and no coinsurance, diagnostic procedures carry a $0 to $30 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under Aetna Medicare Signature Advantage (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Signature Advantage (HMO) plan, as all sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD)—are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature Advantage (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Signature Advantage (HMO) are partially covered, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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