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Aetna Medicare Sound Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Sound Advantage (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 Sound Advantage (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Sound Advantage (HMO-POS) is a HMO-POS 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 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Sound Advantage (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 Sound Advantage (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 Sound Advantage (HMO-POS), 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 $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 $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 Sound Advantage (HMO-POS) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, and a $12.00 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Sound Advantage (HMO-POS) plan offers comprehensive coverage with a range of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. You will also have access to preventive services like annual physical exams and vision and dental services with no or low copays. Additional benefits include hearing services, with no copay for exams and hearing aids covered up to $1500 per year, along with coverage for home health services, medical equipment, and diagnostic services. Emergency, ambulance, and transportation services are covered, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $400 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Sound Advantage (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $300, observation services with a $400 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay of $35 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Sound Advantage (HMO-POS) plan. This benefit has a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Sound Advantage (HMO-POS). Ground Ambulance Services have a $240 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Aetna Medicare Sound Advantage (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $100 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $240 copay. Worldwide Urgent Coverage also has a $100 copay.
Primary Care See details
The Aetna Medicare Sound Advantage (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and specialist services with a $0 - $40 copay. Mental health services, including individual and group sessions, have a $35 copay, and the plan also covers physical therapy and speech-language pathology services with a $20 copay. Additional telehealth benefits include a 20% coinsurance and a $0 - $40 copay, while opioid treatment program services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services, kidney disease education services with 20% coinsurance, and other preventive services with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. The plan does not cover 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, nutritional/dietary benefits, home-based palliative care, in-home support services, or support for caregivers of enrollees.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit coverage of $1500 per year and no copay. OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Routine eye exams, Other Eye Exam Services, Contact Lenses, Eyeglasses (lenses and frames), Eyeglass lenses, Eyeglass frames, and Upgrades have no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay. Other 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Sound Advantage (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered by the Aetna Medicare Sound Advantage (HMO-POS) plan, including durable medical equipment with 20% coinsurance and prosthetics/medical supplies with 20% coinsurance. The plan also covers diabetic equipment, with a coinsurance for Medicare-covered diabetic therapeutic shoes or inserts and a copay for Medicare-covered diabetes supplies.
Diagnostic and Radiological Services See details
Aetna Medicare Sound Advantage (HMO-POS) covers diagnostic and radiological services, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic radiological services have a copay of at most $300, and therapeutic radiological services have a coinsurance of at least 20%, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Sound Advantage (HMO-POS) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Sound Advantage (HMO-POS) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Sound Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $175. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Sound Advantage (HMO-POS) plan covers over-the-counter items with no copay, and a maximum benefit of $45 every three months. Other services like acupuncture, meal benefits, and other services are not covered.
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