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Aetna Medicare Advantra Gold (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Gold (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 Gold (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Gold (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Western Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Gold (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 Gold (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 Gold (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.00. 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 $4900.00 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 Gold (HMO-POS) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance.
Additional Benefits
The Aetna Medicare Advantra Gold (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay, while outpatient services can have copays from $0 to $230, and emergency services have copays ranging from $50 to $125. Many services, such as primary care visits, preventive services, and dental services, come with no copay, while others like hearing and vision exams have copays. This plan also includes coverage for ambulance services, with a $225 copay for ground transport and 20% coinsurance for air transport, as well as $0 copay transportation to a health-related location with limitations. Additionally, the plan covers home health services, and offers benefits like over-the-counter items and eyewear, with maximum benefit limits. However, some services like cardiac rehabilitation and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Inpatient Hospital-Acute has a $350 copay per admission or stay, and additional days are covered with no copay, while Inpatient Hospital Psychiatric has a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $230, Observation Services with a $230 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $40, and Outpatient Blood Services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Gold (HMO-POS) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan. Ground ambulance services have a $225 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay and are limited to 12 one-way trips per year, and 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. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $225 for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services, including routine care, are covered with a $20 copay. Occupational Therapy Services are covered with a $30 copay. Physician Specialist Services are covered with a copay between $0 and $30. Mental Health Specialty Services, including individual and group sessions, are covered with a $40 copay. Podiatry Services, including routine foot care, are covered with a $30 copay. Other Health Care Professional services are covered with a copay between $0 and $30. Psychiatric Services, including individual and group sessions, are covered with a $40 copay. Physical Therapy and Speech-Language Pathology Services are covered with a $30 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services are covered with a $40 copay.
Preventive Services See details
Preventive services include Medicare-covered zero dollar preventive services, annual physical exams with no copay, additional preventive services, kidney disease education services with 20% coinsurance, and other preventive services. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, with no copay, and Wigs for Hair Loss Related to Chemotherapy with no copay and a maximum plan benefit coverage amount of $400 per year. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$30, routine eye exams with no copay, and other eye exam services with no copay. Eyewear benefits are covered with no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. The plan offers a combined maximum of $550 per year for all eyewear.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $30 copay, and other dental services with a $2,500 maximum benefit per year. 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 have no copay. 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. 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 under the Aetna Medicare Advantra Gold (HMO-POS) plan, but require prior authorization. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Advantra Gold (HMO-POS) plan. Durable Medical Equipment (DME) has no copay, and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and coinsurance applies, and Diabetic Equipment is covered with varying coinsurance amounts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $220, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Advantra Gold (HMO-POS) with no copay and no coinsurance. However, 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 Advantra Gold (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan, but require prior authorization. You will have a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Advantra Gold (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $120 every three months, as well as meal benefits and other services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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