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Aetna Medicare Prime Extra (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Extra (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Extra (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Extra (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Prime Extra (HMO) 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 Prime Extra (HMO).
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 Prime Extra (HMO), 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 $300.00 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 $1500.00 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 Prime Extra (HMO) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay when utilizing preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also cost-effective, with copays starting at $10 for a one-month supply at preferred locations and $12 at standard pharmacies. For brand-name and specialty medications, this plan utilizes coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 26% coinsurance across all pharmacy types. Specialty drugs in Tier 5 require a 29% coinsurance for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The Aetna Medicare Prime Extra (HMO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care, specialist, and mental health visits. For hospital care, members pay a $125 copay for days 1 to 5 of acute inpatient stays and a $100 copay for outpatient hospital services, both with no coinsurance. Emergency room visits require a $150 copay, which is waived if you are admitted, while urgent care services feature a $10 copay. Routine vision, hearing, and preventive dental services are covered with no copays or coinsurance, including annual allowances of up to $200 for eyewear and $1,000 per ear for prescription hearing aids. Comprehensive dental treatments are covered with no copay but require a 20% to 50% coinsurance up to a $2,000 annual limit. While home health services are covered with no copay, please note that cardiac rehabilitation, acupuncture, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Aetna Medicare Prime Extra (HMO) covers inpatient hospital services with no coinsurance, requiring a $125 copay for days 1 to 5 of acute stays and a $100 copay for days 1 to 5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Aetna Medicare Prime Extra (HMO) feature no coinsurance, with outpatient hospital services requiring a $100 copay and observation services requiring a $125 copay per stay. Ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Prime Extra (HMO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the service, you will pay a copay of either $55.00 or $180.00.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Prime Extra (HMO), featuring a $250 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Although some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Prime Extra (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $10 copay with no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $150 to $250.
Primary Care See details
Aetna Medicare Prime Extra (HMO) primary care benefits feature no copay and no coinsurance for primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services, while podiatry is not covered. For chiropractic services, some services are covered but routine and other chiropractic services are not covered. Additional telehealth benefits are covered with a $0 to $10 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Prime Extra (HMO) offers preventive services with no copay and no coinsurance for annual physical exams, health education, and various screenings, though kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered, as sub-services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Aetna Medicare Prime Extra (HMO) covers hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids. This benefit is partially covered because OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered, though other prescription hearing aids are covered up to $1,000 per ear every year.
Vision Services See details
Vision services are covered by Aetna Medicare Prime Extra (HMO) with no copay and no coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. Eyewear, such as contacts, eyeglasses, and upgrades, is also covered with no copay and no coinsurance up to a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime Extra (HMO), featuring no copay and no coinsurance for preventive care such as exams, cleanings, and x-rays. Comprehensive treatments like restorative care, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay and a 20% to 50% coinsurance up to a $2,000 annual limit. Fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Prime Extra (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Prime Extra (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Prime Extra (HMO) with no copays, though coinsurance ranging from no coinsurance up to 20% applies depending on the item. This benefit includes durable medical equipment, prosthetics, and diabetic supplies, most of which require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Prime Extra (HMO) with prior authorization required. Diagnostic procedures, lab services, and diagnostic radiological services have no copay and no coinsurance, while therapeutic radiology requires a 20% coinsurance and outpatient X-rays feature no copay but may require coinsurance.
Home Health Services See details
Aetna Medicare Prime Extra (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Prime Extra (HMO), as no sub-services—including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease—are covered by the plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Prime Extra (HMO) with no coinsurance, though prior authorization is required and admission does not require a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Prime Extra (HMO), offering an annual wellness exam, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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