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Aetna Medicare Elite (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 Elite (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Elite (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Northern Virginia. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite (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 Elite (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 Elite (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.00. 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 $615.00 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 $7900.00 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 Elite (HMO-POS) prescription drug coverage features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge low copays, ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply length. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy types. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a 1-month supply.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive medical coverage with affordable cost-sharing, including no copays or coinsurance for primary care visits and routine preventive care. Specialists are accessible with a copay of up to $50, while inpatient hospital stays require a daily copay of $260 to $310 for the first eight days followed by no copay for subsequent days. Outpatient hospital services and diagnostic lab tests are also highly affordable, with lab services requiring no copay and outpatient procedures carrying copays up to $310. For everyday wellness, the plan features dental, vision, and hearing benefits, including no copays for routine dental cleanings, annual eye exams, and routine hearing tests. Vision and hearing coverage also include allowances, such as a $100 annual eyewear allowance and up to $500 per ear for prescription hearing aids with no copays. Additionally, emergency care is covered with a $115 copay, which is waived upon hospital admission, and urgent care visits require a $40 copay.
Inpatient Hospital See details
Aetna Medicare Elite (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $310 daily copay for days 1-8 of acute stays and a $260 daily copay for days 1-8 of psychiatric stays, followed by no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $310, observation services require a $310 copay per stay, and outpatient substance abuse sessions carry a $40 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Elite (HMO-POS) with a copay of $105 or $110 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (HMO-POS) covers ground ambulance services with a $275 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered under this plan.
Emergency Services See details
Aetna Medicare Elite (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Primary care benefits under Aetna Medicare Elite (HMO-POS) feature no copay and no coinsurance for primary care visits, and a $0 to $50 copay with no coinsurance for specialists. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Elite (HMO-POS), offering no copay and no coinsurance for annual physicals, health education, and fitness benefits, while kidney disease education requires no copay but carries a 20% coinsurance. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Elite (HMO-POS), featuring Medicare-covered exams for a $50 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (HMO-POS) with no coinsurance or deductibles, featuring eye exams with a $0 to $50 copay and eyewear with no copay. This includes one routine eye exam per year at no copay and a $100 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (HMO-POS), offering Medicare-covered dental care for a $50 copay and no coinsurance, alongside select preventive services like cleanings, exams, and X-rays with no copay and no coinsurance. Comprehensive treatments—including restorative, endodontic, periodontic, and orthodontic services—as well as fluoride and other diagnostic dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (HMO-POS) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite (HMO-POS) with no copays and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Elite (HMO-POS) with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic procedures require a $0 to $100 copay with no coinsurance, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Elite (HMO-POS) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Aetna Medicare Elite (HMO-POS) offers cardiac rehabilitation services with no coinsurance, though only some services are covered. The plan does not cover cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services (each with a $20 copay), as well as pulmonary rehabilitation services (with a $15 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Elite (HMO-POS) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay applies for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite (HMO-POS) partially covers other services, 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.
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