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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 Northeastern 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 $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 $7500.00 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 an enhanced alternative drug benefit. The plan has a $590 deductible. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. Preferred Generic drugs 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, depending on the tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Advantra Gold (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services, such as primary care visits, preventive services, routine hearing and eye exams, and many dental services. The plan has copays for services like inpatient hospital stays, outpatient services, specialist visits, and emergency services. It also covers services like ambulance and transportation, hearing aids, and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For Inpatient Hospital-Acute, there is a $425 copay per admission or stay, and additional days have no copay; however, Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric services, there is a $350 copay for days 1-5, and no copay for days 6-90; however, additional days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan. Outpatient hospital services have a copay between $0 and $250, observation services have a $250 copay, ambulatory surgical center services have no copay, and individual and group outpatient substance abuse sessions have a $30 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Gold (HMO-POS) plan with prior authorization required, and there is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services. Ground ambulance services have a $300 copay, while air ambulance services have 20% coinsurance, and transportation services to a plan-approved health-related location have no copay for up to 6 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay. Chiropractic Services have a $15 copay, and Routine Chiropractic Care has a $15 copay for up to 12 visits per year. Occupational Therapy Services have a $35 copay, Physician Specialist Services have a $30 copay, and Mental Health Specialty Services have a $30 copay for both individual and group sessions. Podiatry Services have a $30 copay, and Routine Foot Care is covered up to 4 visits per year. Other Health Care Professional visits have a copay between $0 and $30, and Psychiatric Services have a $30 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Aetna Medicare Advantra Gold (HMO-POS) covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including 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
Aetna Medicare Advantra Gold (HMO-POS) covers hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a maximum plan benefit of $500 per year.
Vision Services See details
The Aetna Medicare Advantra Gold (HMO-POS) plan covers vision services including eye exams with a copay of $0-$30, and routine eye exams and other eye exam services with no copay. Eyewear is covered with no copay, with a combined maximum plan benefit of $340 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Advantra Gold (HMO-POS) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Medicare dental services have a $30 copay, and the plan has a $2,200 annual maximum for other dental services. 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Gold (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with a coinsurance of 0% to 20% for supplies and 20% for therapeutic shoes/inserts. Durable medical equipment for use outside of the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. The plan has no copay for diagnostic procedures/tests and lab services. Radiological services are covered with a copay of up to $250 for diagnostic services and a 20% coinsurance for therapeutic services; outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan, but the specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Gold (HMO-POS) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100, with no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays 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. The plan also covers meal benefits and other services with no copay, but does not cover acupuncture.
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