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Aetna Medicare Advantra Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Premier (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 Premier (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Premier (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Premier (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 Premier (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 Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 Premier (HMO-POS) plan features an annual prescription drug deductible of $615. You can save on lower-tier medications, as there is no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at preferred pharmacies or through preferred mail order. Standard pharmacies and standard mail order services charge a small copay for these tiers, starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications under this plan require coinsurance instead of flat copayments. For Tier 3 preferred brand drugs, you will pay a 24% coinsurance regardless of the pharmacy or supply length you choose. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for a one-month supply across all pharmacy and mail order channels.
Additional Benefits
The Aetna Medicare Advantra Premier (HMO-POS) plan offers comprehensive healthcare coverage featuring no copay for primary care doctor visits, annual physicals, and routine preventive screenings. Specialist office visits range from no copay to a $30 copay, while inpatient hospital stays require a $379 copay per admission with no coinsurance. Additionally, emergency room visits have a $130 copay and urgent care services require a $50 copay. For routine care, the plan provides dental, vision, and hearing benefits, including no copay for routine eye exams, eyewear up to a $350 annual limit, and preventive dental cleanings. Prescription hearing aids are covered up to $500 per ear annually with no copay, and comprehensive dental services are covered up to a $2,500 yearly limit. Members also benefit from home health services with no copay and a $75 quarterly over-the-counter allowance.
Inpatient Hospital See details
Aetna Medicare Advantra Premier (HMO-POS) covers inpatient acute hospital stays with a $379 copay per admission and no coinsurance, including unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance, requiring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90, though non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Aetna Medicare Advantra Premier (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $230, plus observation services for a $230 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copays or 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 Premier (HMO-POS) with costs ranging from no copay to a $145 copay, and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services under Aetna Medicare Advantra Premier (HMO-POS) include ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, but transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Advantra Premier (HMO-POS) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $250,000 maximum, requiring copays of $130 for emergency or urgent care and $225 for emergency transportation.
Primary Care See details
Primary care services under Aetna Medicare Advantra Premier (HMO-POS) feature no copay and no coinsurance for primary care doctor visits, and a $0 to $30 copay with no coinsurance for specialists. Chiropractic care is partially covered, excluding other chiropractic services, with a $15 copay and no coinsurance for routine visits. Therapy, mental health, and podiatry services have copays ranging from $30 to $40 with no coinsurance, while telehealth benefits require a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered under Aetna Medicare Advantra Premier (HMO-POS), featuring an annual physical, select screenings, and fitness benefits with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services not covered under this plan include 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/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Advantra Premier (HMO-POS) hearing services include Medicare-covered exams for a $30 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Advantra Premier (HMO-POS) with no deductibles and no coinsurance, featuring eye exam copays ranging from no copay to $30.00. Routine annual eye exams, follow-up diabetic eye exams, and eyewear—including contacts and eyeglasses—all have no copay, with eyewear covered up to a $350.00 maximum limit per year.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Advantra Premier (HMO-POS), offering preventive care like exams and cleanings with no copay and no coinsurance, and comprehensive benefits with no copay and 20% to 50% coinsurance up to a $2,500 annual maximum. Medicare-covered dental services require a $30 copay and no coinsurance, but 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 Premier (HMO-POS) with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Advantra Premier (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Advantra Premier (HMO-POS) covers medical equipment, prosthetics, and diabetic supplies with no copay and coinsurance ranging from 0% to 20% depending on the item. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Premier (HMO-POS) covers diagnostic tests and lab services with no copay and no coinsurance, and diagnostic radiological services with no copay. Outpatient X-rays require a $20 copay, therapeutic radiological services require 20% coinsurance, and prior authorization is required for diagnostic and radiological services.
Home Health Services See details
Aetna Medicare Advantra Premier (HMO-POS) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Advantra Premier (HMO-POS) plan with no copay and no coinsurance, although only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Premier (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Advantra Premier (HMO-POS) partially covers other services with no copay and no coinsurance, which includes a $75 quarterly over-the-counter allowance, chronic illness meals, and extra wellness exams. Acupuncture is not covered under this benefit.
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