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Aetna Medicare Advantra Signature (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Signature (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 Signature (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Signature (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 Signature (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 Signature (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 Signature (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 a $500.00 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 Signature (HMO-POS) plan features an annual drug deductible of $500. Under this plan, you will enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs have a copay of $2 to $6, while Tier 2 drugs carry a copay ranging from $12 to $36 depending on the supply duration. For higher-tier medications, the plan transitions to a coinsurance structure across all pharmacy and mail-order options. You will pay a 22% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred) drugs. Specialty Tier 5 drugs require a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Advantra Signature (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive screenings, and home health services. For specialized care, members generally face low out-of-pocket costs, including a $0 to $35 copay for specialist visits and a $35 copay for physical therapy and mental health services. Inpatient hospital stays require a $260 daily copay for the first seven days of acute care, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also includes valuable everyday wellness benefits, such as routine vision and hearing exams with no copay, alongside allowances for prescription hearing aids and eyewear. Preventive dental care like cleanings and exams are available with no copay, while comprehensive dental services require coinsurance up to a $750 annual maximum. Additionally, members benefit from diagnostic lab tests with no copay and a quarterly $30 over-the-counter reimbursement to help manage daily health needs.
Inpatient Hospital See details
Aetna Medicare Advantra Signature (HMO-POS) partially covers inpatient hospital stays with no coinsurance, requiring a $260 copay for days 1 to 7 of acute care and a $176 copay for days 1 to 9 of psychiatric care, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $260 copay for outpatient hospital services and a $260 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Advantra Signature (HMO-POS) with no coinsurance and copays ranging from no copay to $145. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, and worldwide emergency transportation is covered with a $225 copay, featuring no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Advantra Signature (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Other services like physical therapy, mental health, and podiatry generally require a $35 copay and no coinsurance, though for chiropractic care some services are covered but routine and 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 under the Aetna Medicare Advantra Signature (HMO-POS) plan are partially covered, offering key benefits like annual physical exams and screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Supplemental services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers Medicare-covered hearing exams with a $35 copay and no coinsurance, while routine exams and fitting evaluations are covered 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 devices are not covered.
Vision Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers vision services with no coinsurance and no deductible, offering routine eye exams with no copay and Medicare-covered exams with a $0 to $35 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to a $175 annual maximum benefit limit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Signature (HMO-POS), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care like cleanings and exams. Comprehensive options like restorative and endodontic services have no copay and 20% to 50% coinsurance up to a $750 annual maximum, while fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Advantra Signature (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra Signature (HMO-POS) with no copay, though prior authorization is required. Durable medical equipment, medical supplies, and diabetic supplies feature coinsurance ranging from no coinsurance to 20%, while prosthetic devices and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Advantra Signature (HMO-POS), with prior authorization required for all services. Diagnostic tests, lab services, and diagnostic radiology have no copay and no coinsurance, while outpatient x-rays require a $20 copay and therapeutic radiology has a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Advantra Signature (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra Signature (HMO-POS) covers cardiac rehabilitation services with no copay and no coinsurance, but in practice, some services are covered while 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 Signature (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, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Aetna Medicare Advantra Signature (HMO-POS) partially covers other services with no copay and no coinsurance, which includes chronic illness meals, annual wellness exams, and a $30 quarterly over-the-counter reimbursement. Acupuncture is not covered under this benefit.
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