A non-government entity
Aetna Medicare Premier 1 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier 1 (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 Premier 1 (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier 1 (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Denver Metro & Northern Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier 1 (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 Premier 1 (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 Premier 1 (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 $3900.00 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:
Sign up for Aetna Medicare Premier 1 (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Premier 1 (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12.00 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance, depending on the drug and pharmacy.
Additional Benefits
The Aetna Medicare Premier 1 (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, with costs differing between acute and psychiatric services. Outpatient services have copays depending on the specific service, and emergency services have a copay. This plan covers primary care visits and many specialist services with no copay, and preventive services like annual physical exams are also available at no cost. Vision and dental services, including exams and eyewear, are available with no copay, and hearing exams also have no copay. The plan also includes coverage for ambulance, home health, home infusion, and dialysis services, with varying copays and coinsurance, and offers an over-the-counter (OTC) benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $205 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric services have a $370 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare-covered stays for both are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Premier 1 (HMO-POS) covers partial hospitalization with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier 1 (HMO-POS) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier 1 (HMO-POS) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a copay of $140 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $200 copay for Worldwide Emergency Transportation.
Primary Care See details
Aetna Medicare Premier 1 (HMO-POS) covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $15 copay, and specialist services with a copay between $0 and $40. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay. Other preventive services are covered, and some services have a $0 copay, including Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids, each with no copay and one visit covered per year; prescription hearing aids are covered with a maximum benefit of $1,250 per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams and other eye exam services. Eyewear also has no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $185 per year.
Dental Services See details
Dental services are covered, 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, all with no copay. Medicare dental services have a $40 copay and require prior authorization, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 Premier 1 (HMO-POS) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment have no copay, and coinsurance applies to Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, Medicare-covered Diabetic Supplies, and Medicare-covered Diabetic Therapeutic Shoes or Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $100, Therapeutic Radiological Services with a $60 copay, and Outpatient X-Ray Services with a $10 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier 1 (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 Premier 1 (HMO-POS) plan. While the plan covers some Cardiac Rehabilitation Services, the specific services listed are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier 1 (HMO-POS) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Premier 1 (HMO-POS) plan offers over-the-counter (OTC) items with no copay, and a maximum benefit of $30 every three months. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and private duty nursing services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved