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Aetna Medicare Sunrise (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Sunrise (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 Sunrise (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Sunrise (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Pima County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Sunrise (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 Sunrise (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 Sunrise (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. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced 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 $2700.00 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 Sunrise (HMO-POS) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay varying costs depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance, depending on the specific drug and pharmacy. 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 Sunrise (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays that vary depending on the service. Emergency, primary care, preventive, vision, and dental services often have no copay. This plan also covers hearing services, with no copay for exams and hearing aid fittings, as well as a yearly allowance for hearing aids. Other covered services include ambulance, home health, and skilled nursing facility services, each with its own specific copay or coinsurance structure.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Aetna Medicare Sunrise (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-5 and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5 and no copay for days 6-90. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include all outpatient hospital services with a copay between $0 and $225, observation services with a $175 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay of $40 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 Sunrise (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 Sunrise (HMO-POS) plan. Ground Ambulance Services have a $290 copay, while Air Ambulance Services have a 20% coinsurance; however, 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 Sunrise (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay with no coinsurance, Urgently Needed Services has a $50 copay with no coinsurance, and Worldwide Emergency Transportation has a $290 copay with no coinsurance.
Primary Care See details
Under the Aetna Medicare Sunrise (HMO-POS) plan, primary care physician services have no copay, and chiropractic services have a $20 copay. Occupational therapy services have a $5 copay, while physical therapy and speech-language pathology services also have a $5 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, while other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit also have no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1250.00 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Sunrise (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay. There is a combined maximum plan benefit coverage of $200.00 every year for all eyewear.
Dental Services See details
Dental services are covered, with a $25 copay for Medicare dental services. 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Sunrise (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Sunrise (HMO-POS), including Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0-20% coinsurance. Diabetic equipment is covered with coinsurance and copay, Diabetic Supplies with 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $175, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Sunrise (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 Sunrise (HMO-POS) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Sunrise (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $196 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Sunrise (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum benefit of $45 every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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