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Aetna Medicare Premium Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premium Plus (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 Premium Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premium Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premium Plus (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 Premium Plus (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 Premium Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.00. 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 $4000.00 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 Premium Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after the deductible is met, you'll pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies, while standard pharmacies will have a $12 copay. For standard generic, preferred brand, and non-preferred drugs, you will pay 22% or 25% coinsurance depending on the tier and pharmacy. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premium Plus (HMO-POS) plan offers comprehensive coverage for various healthcare needs. This plan includes coverage for inpatient and outpatient services, with copays ranging from $0 to $370 depending on the service. It also covers emergency services, primary care, preventive services, vision, dental, hearing, and home health services, often with no copay or low copays. In addition to standard Medicare benefits, this plan provides coverage for services like hearing aids, eyewear, and dental care, subject to specific annual limits. You'll also find coverage for services like ambulance, medical equipment, and diagnostic services with varying copays and coinsurance. The plan also has additional benefits like over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
The Aetna Medicare Premium Plus (HMO-POS) plan covers inpatient hospital stays, including services not usually covered by Medicare, but requires prior authorization. For acute inpatient hospital stays, there is a $225 copay for days 1-5, and no copay for days 6-90. For inpatient psychiatric stays, there is a $370 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay. Non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare covered stays for inpatient hospital psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $0-$350, observation services with a $350 copay, Ambulatory Surgical Center (ASC) services with no copay, individual and group sessions for outpatient substance abuse with a $40 copay, and outpatient blood services with no copay. This plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premium Plus (HMO-POS) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premium Plus (HMO-POS) plan. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance. 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 Premium Plus (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency and Urgent Coverage, and a $260 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Premium Plus (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $30 copay, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services and Psychiatric Services have a copay of $40 for individual and group sessions, and Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services also have a $40 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services and annual physical exams with no copay, and other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, also with no copay. Other services, like wigs for chemotherapy-related hair loss, health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, are covered with a $0 copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with no copay, and you are eligible for one routine hearing exam and one fitting/evaluation per year. Prescription hearing aids are covered, with a maximum benefit of $1,250 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare Premium Plus (HMO-POS) plan. Eye exams and eyewear have no copay, with a combined maximum benefit of $275 per year for eyewear.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $30 copay, and other services like oral exams, dental x-rays, and cleanings with no copay. This plan has a maximum benefit of $2,000 per year. 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 for a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premium Plus (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Premium Plus (HMO-POS) plan, including Durable Medical Equipment (DME) with no copay and 0%-20% coinsurance, Prosthetics and Medical Supplies with no copay and coinsurance for some services, and Diabetic Equipment with coinsurance and prior authorization required. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $20 for diagnostic procedures/tests, and no copay for lab services. Radiological Services include copays for diagnostic and therapeutic radiological services, and a 20% coinsurance for therapeutic radiological services. Outpatient X-Ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premium Plus (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 Premium Plus (HMO-POS) plan, but the plan does not cover any specific services. The copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premium Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for over-the-counter items and meal benefits with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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