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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 2025, 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 Northwestern 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 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 $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 $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 $5900.00 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 has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, you'll pay a $0 copay for preferred generic drugs at preferred pharmacies and mail order pharmacies. You will pay 24% coinsurance for standard generic drugs and 25% coinsurance for preferred brand and non-preferred drugs. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Advantra Premier (HMO-POS) plan offers a variety of benefits with varying cost-sharing arrangements. The plan covers inpatient hospital stays with a copay per admission, and outpatient services with copays depending on the service. Other benefits include coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility services. This plan offers many services with no copay, including many outpatient services, partial hospitalization, transportation to health-related locations, primary care, preventive services, hearing exams, vision services, dental services, home health services, and other services. However, some services require coinsurance, such as air ambulance, dialysis, medical equipment, and diagnostic radiological services. Prior authorization may be required for some services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with prior authorization required. For Inpatient Hospital-Acute, there is a $425 copay per admission or stay for Medicare-covered stays, and additional days have no copay. Inpatient Hospital Psychiatric has a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $250, observation services with a $250 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay, and outpatient blood services with no copay. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Premier (HMO-POS) plan, but requires prior authorization. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $240 copay, and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 6 one-way trips per year.
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 a $240 copay for Worldwide Emergency Transportation.
Primary Care See details
Aetna Medicare Advantra Premier (HMO-POS) covers primary care services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a $0-$40 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, opioid treatment program services, and additional telehealth benefits are also covered, but have varying copays. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance and a $0-$50 copay.
Preventive Services See details
Preventive Services include annual physical exams, with no copay, and additional preventive services which may have a copay. Kidney Disease Education Services have a 20% coinsurance. 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 $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum plan benefit coverage of $500 per ear every year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Advantra Premier (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Routine eye exams are covered with no copay for one visit per year, and other eye exam services are covered with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, with a combined maximum of $300 per year.
Dental Services See details
Dental services with the Aetna Medicare Advantra Premier (HMO-POS) plan include Medicare dental services with a $40 copay, and other dental services, with a $1,250 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Premier (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Advantra Premier (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services with no copay, while outpatient X-ray services have a $20 copay. Diagnostic radiological services have a maximum copay of $225, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Premier (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some services, but the specific amount is not listed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is a $10 copay, 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
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits 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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