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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 Cochise, Gila and Santa Cruz Counties. 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.
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 $5500.00 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 $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the following costs for your drugs. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $12.00 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance depending on the pharmacy and drug tier. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Sunrise (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services may have copays depending on the specific service. Emergency services and primary care visits typically have copays, while preventive services, hearing exams, vision services, and dental services have no copay. Additional benefits include coverage for ambulance services, home health, home infusion, and medical equipment, with some services requiring copays or coinsurance. The plan also covers skilled nursing facility stays, with a copay after the first 20 days, and offers other services such as Over-the-Counter (OTC) items with an annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $295 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are also covered, with a copay of $370 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 coverage for all outpatient hospital services, with a copay between $0 and $295, observation services with a $295 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Sunrise (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this service.
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; Transportation Services are not covered.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance, and Urgently Needed Services are covered with a $55 copay and no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $290 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Sunrise (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 are covered with a copay between $0 and $40. Mental health and psychiatric services, including individual and group sessions, are covered with a $40 copay. Physical therapy and speech-language pathology services are covered with a $30 copay, and additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $55.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with a copay for services like Health Education, and Fitness Benefit. Kidney Disease Education Services have a 20% coinsurance, and Other Preventive Services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered, but inner ear, outer ear, and over-the-ear prescription 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, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay. The plan offers a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare dental services, and a $1,000 maximum plan benefit per year. 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), prosthodontics (fixed), and oral and maxillofacial surgery are covered with no copay, while 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 benefits are covered by Aetna Medicare Sunrise (HMO-POS), including Durable Medical Equipment with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment, with Diabetic Supplies having 0% to 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, including diagnostic procedures/tests, lab services, and outpatient x-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 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 covered by the Aetna Medicare Sunrise (HMO-POS) plan, but the specific services listed, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for some 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 Sunrise (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with no copay, and an annual maximum benefit of $30 every three months. Acupuncture, Meal Benefit, 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. Other 1 and Other 2 benefits are covered with no copay.
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