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Aetna Medicare Advantra Silver (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Silver (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 Silver (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Silver (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 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Silver (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 Silver (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 Silver (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 Silver (HMO-POS) plan has an enhanced alternative drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies and a $12 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance. The plan offers mail order options with the same cost-sharing as retail pharmacies.
Additional Benefits
The Aetna Medicare Advantra Silver (HMO-POS) plan offers a range of benefits with varying cost-sharing. Hospital stays have copays, while many outpatient services like primary care and preventive services have no copay. Additionally, the plan covers emergency services, hearing, vision, and dental services with specific copays or coinsurance amounts. This plan also includes coverage for home health, medical equipment, and home infusion services, with some services requiring coinsurance. Other benefits include coverage for ambulance services, mental health services, and prescription hearing aids. However, it's important to note that certain services, like transportation and some dental and vision services, may have limitations or require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $260 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $176 copay for days 1-9, and no copay for days 10-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $260, and Observation Services have a $260 copay; all other services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Silver (HMO-POS) plan, with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Aetna Medicare Advantra Silver (HMO-POS) plan covers ambulance services, with a $225 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 under the Aetna Medicare Advantra Silver (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services include a $125 copay for Worldwide Emergency and Urgent Coverage and a $225 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care, including Primary Care Physician Services, is covered with no copay. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Occupational Therapy Services are covered with a $40 copay, while Physician Specialist Services are covered with a copay between $0 and $40. Mental Health Specialty Services, including individual and group sessions, are covered with a $35 copay. Podiatry Services, including routine foot care, are covered with a $40 copay for up to 4 visits per year. Other Health Care Professional services are covered with a copay between $0 and $40, while Psychiatric Services, including individual and group sessions, are covered with a $35 copay. Physical Therapy and Speech-Language Pathology Services are covered with a $40 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 $35 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services. In addition, this plan covers kidney disease education services with a 20% coinsurance. Other preventive services include coverage for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay, with routine hearing exams and fitting/evaluation for hearing aids covered with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear, with prescription hearing aids (all types) covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$40, and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $335 per year.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, and no copay for 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), prosthodontics (fixed), and oral and maxillofacial surgery. 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 under the Aetna Medicare Advantra Silver (HMO-POS) plan. 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 by the Aetna Medicare Advantra Silver (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by Aetna Medicare Advantra Silver (HMO-POS). Durable Medical Equipment has a coinsurance of 0% to 20% with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Medical Supplies and Diabetic Supplies have a coinsurance of 0% to 20%, with no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay up to $225.00, and Outpatient X-Ray Services have a $20.00 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Silver (HMO-POS) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Advantra Silver (HMO-POS) plan, though specific services like Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Silver (HMO-POS) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Advantra Silver (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit coverage amount of $105 every three months. Other services like Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services, Services in an Intermediate Care Facility, 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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