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Aetna Medicare Select (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Select (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 Select (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Select (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Select (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 Select (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 Select (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 $250.00 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 $5900.00 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 Select (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Select (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a copay, as well as outpatient services, emergency services, and primary care with varying copays. Additional benefits include preventive, hearing, vision, and dental services with no copays for many services. The plan also covers home health, skilled nursing, and medical equipment with varying cost-sharing.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $374 for days 1-8 and no copay for days 9-90 for acute care, and a copay of $286 for days 1-8 and no copay for days 9-90 for psychiatric care. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare-covered stays and upgrades for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $374, while observation services have a $374 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Select (HMO-POS) plan with a $105 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Select (HMO-POS) plan. Ground ambulance services have a $275 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 under the Aetna Medicare Select (HMO-POS) plan. Emergency Services has a $125 copay and no coinsurance, Urgently Needed Services has a $55 copay and no coinsurance, and Worldwide Emergency Services has a $125 or $275 copay depending on the service, and no coinsurance.
Primary Care See details
The Aetna Medicare Select (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and specialist services with a copay between $0 and $40. Mental health specialty services and psychiatric services, including individual and group sessions, have a $40 copay, while physical and speech therapy services have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, as well as additional services such as Health Education, Wigs for Hair Loss, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, which may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay for up to 1 exam per year, and fitting/evaluation for hearing aids with no copay for up to 1 exam per year. Prescription hearing aids are covered, with a maximum benefit of $1500 per year, and prescription hearing aids of all types have no copay for up to 2 visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Select (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Routine eye exams have no copay and are limited to one per year, while other eye exam services have no copay and are unlimited. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay, and a combined maximum benefit of $240 per year.
Dental Services See details
The Aetna Medicare Select (HMO-POS) plan covers dental services, 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 with no copay. Medicare dental services have a $40 copay, and orthodontics and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Select (HMO-POS) plan, but prior authorization is required. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Select (HMO-POS), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment with a coinsurance between 0% and 20% and no copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with the plan requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $250, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Select (HMO-POS) plan 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 by Aetna Medicare Select (HMO-POS), but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for these services is not described.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for over-the-counter items and meal benefits with no copay, and also covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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