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Aetna Medicare Elite (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 Elite (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Elite (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite (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 Elite (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 Elite (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 $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 $9250.00 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 Elite (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For brand-name and specialty medications, costs transition to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. Specialty drugs under Tier 5 are limited to a one-month supply at this 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive medical coverage with affordable out-of-pocket costs, featuring a $15 copay for primary care visits and copays ranging from no copay to $55 for specialists. For hospital stays, members pay a $345 daily copay for the first five days of inpatient care with no copay thereafter, while outpatient hospital services range from no copay to a $340 copay. Emergency care is available with a $115 copay, which is waived upon hospital admission, and urgent care visits require a $40 copay. This plan also includes valuable preventive and supplemental benefits, including no copay for routine dental cleanings, routine hearing exams, and annual physicals. Vision care is covered with no copay for eyewear alongside a $100 annual allowance, while prescription hearing aids are covered up to $500 per ear annually with no copay. Additionally, diagnostic lab services and home health care are provided with no copay, helping members manage their health with minimal extra expenses.
Inpatient Hospital See details
Inpatient hospital coverage under Aetna Medicare Elite (HMO-POS) features no coinsurance, with acute stays requiring a $345 daily copay for days 1 to 5 (no copay thereafter) and psychiatric stays requiring a $218 daily copay for days 1 to 8 (no copay thereafter). While unlimited additional acute days are covered at no cost, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from no copay to $340 and observation services with a $340 copay per stay. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Elite (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
Aetna Medicare Elite (HMO-POS) covers ground ambulance services with a $275 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
Aetna Medicare Elite (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, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum plan benefit with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Aetna Medicare Elite (HMO-POS) primary care benefits feature a $15 copay and no coinsurance for primary care visits, and specialist visits ranging from no copay to a $55 copay with no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, while chiropractic and podiatry services are not covered. Mental health, psychiatric, and opioid treatment sessions have a $40 copay with no coinsurance, and telehealth benefits carry a 20% coinsurance and copays up to $55.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (HMO-POS), featuring no copay and no coinsurance for annual physicals and most screenings, though kidney disease education requires a 20% coinsurance with no copay. Several supplemental services are not covered under this plan, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Aetna Medicare Elite (HMO-POS) offers partially covered hearing services, with Medicare-covered exams requiring a $55 copay and no coinsurance, and routine exams and fittings available with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance; however, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (HMO-POS) with no deductibles and no coinsurance, featuring a copay of $0 to $55 for eye exams and no copay for eyewear. This benefit includes one routine eye exam per year and a $100 annual maximum allowance toward contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (HMO-POS), featuring Medicare-covered dental services for a $55.00 copay and no coinsurance, and select preventive care with no copay and no coinsurance. Covered preventive services include up to four oral exams, two cleanings, and one set of X-rays per year, while fluoride, restorative, endodontic, periodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (HMO-POS) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Elite (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (HMO-POS), with prior authorization required for all services. Diagnostic tests and procedures have no coinsurance and range from no copay to a $100 copay, while lab services have no copay. For radiological services, outpatient X-rays carry a $15 copay, diagnostic radiology starts at no copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Elite (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under Aetna Medicare Elite (HMO-POS), but specific sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and carry copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (HMO-POS) partially covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $180 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Elite (HMO-POS) partially covers other services, offering select benefits like annual wellness exams, screening mammographies, and additional gFOBT and FIT tests with no copay and no coinsurance. However, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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