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Aetna Medicare Advantra Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Enhanced (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 Advantra Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Allegheny County. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Enhanced (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 Advantra Enhanced (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 Advantra Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.00. 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 $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 Advantra Enhanced (HMO-POS) plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service for any supply length. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply duration. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for all pharmacy and mail-order choices. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Enhanced (HMO-POS) plan offers robust medical coverage featuring no copay for primary care visits and low copays up to $30 for specialist consultations. For hospital care, inpatient acute stays require a $350 copay, while emergency room visits carry a $130 copay that is waived upon admission. Outpatient procedures and diagnostic services are similarly affordable, with many services requiring no copay and no coinsurance. Additionally, the plan provides excellent supplemental benefits, including routine dental, vision, and hearing exams with no copay. Members benefit from generous allowances, such as up to $250 annually for eyewear, up to $500 per ear for prescription hearing aids, and a $45 quarterly over-the-counter reimbursement. Comprehensive dental services are also covered with coinsurance ranging from 20% to 50% up to a $1,250 annual maximum.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no coinsurance, requiring a $350 copay per acute stay and a $350 daily copay for days 1 through 5 of psychiatric stays, with no copay for additional acute days or psychiatric days 6 through 90. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Advantra Enhanced (HMO-POS) with copays ranging from no copay to $145 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Advantra Enhanced (HMO-POS) with a $225 copay (and no coinsurance) for ground transportation and a 20% coinsurance (and no copay) for air transportation, with prior authorization required for both. Routine transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency and urgent services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $225.
Primary Care See details
Aetna Medicare Advantra Enhanced (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $30 copay with no coinsurance. Most other services, including therapy, psychiatric, and podiatry visits, feature copays between $30 and $40 with no coinsurance, though chiropractic care is only partially covered because other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered under Aetna Medicare Advantra Enhanced (HMO-POS), with most covered benefits—including annual physicals, health education, and select screenings—offered with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services, such as personal emergency response systems, weight management, and nutritional benefits, are not covered.
Hearing Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers vision services with no deductibles and no coinsurance. Eye exams have a copay ranging from $0 to $30, which includes one annual routine exam with no copay, and eyewear is covered with no copay up to a $250 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Enhanced (HMO-POS), featuring preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $30 copay and no coinsurance. Comprehensive benefits like restorative and endodontic care are covered with no copay and 20% to 50% coinsurance up to a $1,250 annual maximum, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Advantra Enhanced (HMO-POS) with no copays, though prior authorization is required. Members will pay no coinsurance to 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices require 20% coinsurance and diabetic therapeutic shoes or inserts require 15% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers diagnostic procedures, tests, and lab services with no copay and no coinsurance. Outpatient x-rays require a $10 copay, therapeutic radiological services carry a 20% coinsurance, and prior authorization is required for these diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) partially covers other services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $45 quarterly over-the-counter reimbursement, chronic illness meal benefits, annual wellness exams, and additional colorectal screenings.
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