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Aetna Medicare Platinum (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Platinum (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 Platinum (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Platinum (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in COC, GIL, MAR, MOH, PIM, PIN and YAV Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Platinum (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 Platinum (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 Platinum (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 $4900.00 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 Platinum (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 the pharmacy you use. For drugs in the Preferred Generic tier, you will pay no copay at preferred pharmacies or mail order, and a $12 copay at standard pharmacies. For other tiers, you will pay 24% or 25% coinsurance depending on the drug. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Platinum (HMO-POS) plan offers comprehensive coverage with a variety of benefits. You'll find that many services have no copay, including primary care, vision, dental, and home health services. The plan also provides coverage for inpatient and outpatient services, emergency care, hearing, and preventive services. This plan has copays for some services, such as hospital stays, specialist visits, and ambulance services. There is also coinsurance for some services, including air ambulance, dialysis, and medical equipment. Overall, this plan aims to provide a balance of coverage with a range of costs for different healthcare needs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Inpatient Hospital-Acute has a copay of $190 for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a copay of $370 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered by the Aetna Medicare Platinum (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $315, observation services have a $190 copay, individual and group sessions for outpatient substance abuse have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Platinum (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Platinum (HMO-POS) plan. Ground ambulance services have a $315 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 the Aetna Medicare Platinum (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation has a $315 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Platinum (HMO-POS) plan covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. Physician specialist services have a copay between $0 and $30, and physical therapy and speech-language pathology services have a $30 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a $20 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $55. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services with no copay, including health education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services are covered with 20% coinsurance. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, with specific copays or maximum benefit amounts.
Hearing Services See details
The Aetna Medicare Platinum (HMO-POS) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and routine hearing exams, and prescription hearing aids (all types) with no copay. Prescription hearing aids have a maximum plan benefit coverage of $1250.00 per year. OTC hearing aids, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with no copay for any service. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $325 per year, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no limits on coverage.
Dental Services See details
The Aetna Medicare Platinum (HMO-POS) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, other preventative services, restorative services, adjunctive services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Medicare dental services require a $40 copay, and orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $2,500 maximum plan benefit for other dental services, renewed annually.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Platinum (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Platinum (HMO-POS) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies and Diabetic Supplies with a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Platinum (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Radiological services have a copay of at most $200 for diagnostic services, and a coinsurance of at least 20% for therapeutic services. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Platinum (HMO-POS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Platinum (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Platinum (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $196. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Platinum (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum plan benefit coverage of $30 every three months. Other services such as acupuncture, meal benefits, and many others are not covered.
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