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Aetna Medicare Advantra Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Enhanced (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 Enhanced (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Enhanced (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.00. 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 $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 Enhanced (HMO-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options carry a copay ranging from $2 to $6 for Tier 1, and $12 to $36 for Tier 2, depending on the supply duration. Higher-tier medications under this plan utilize coinsurance instead of flat copays for all pharmacy and mail-order options. You will pay a 24% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also incur a 25% coinsurance, which is only available for a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Enhanced (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, members pay a $35 copay, while inpatient hospital stays require a $275 daily copay for the first seven days and no copay thereafter. Outpatient hospital services generally feature no coinsurance, with copays ranging from no copay up to $275. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copays. Vision coverage features a $300 annual eyewear allowance, while dental benefits cover preventive care with no copay and comprehensive services with a 20% to 50% coinsurance up to a $1,500 yearly limit. Additionally, members receive up to a $500 hearing aid allowance per ear and a $90 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care under Aetna Medicare Advantra Enhanced (HMO-POS) is partially covered with no coinsurance, though prior authorization is required. For acute stays, there is a $275 daily copay for days 1-7 and no copay for day 8 and beyond, while psychiatric stays require a $350 daily copay for days 1-5 and no copay for days 6-90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) outpatient services feature no coinsurance, with copays ranging from $0 to $275 for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Advantra Enhanced (HMO-POS) with either no copay or a $110 copay, and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Advantra Enhanced (HMO-POS), featuring a $260 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for ambulance transport, and transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays of $115 for emergency or urgent care and $260 for emergency transportation.
Primary Care See details
Aetna Medicare Advantra Enhanced (HMO-POS) provides primary care physician services with no copay and no coinsurance, while most specialist, therapy, and mental health visits require a $35 copay and no coinsurance. Chiropractic services are partially covered, offering routine care with a $15 copay for up to 12 visits per year, though other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance for most covered services, except for kidney disease education which has a 20% coinsurance and no copay. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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
Hearing services are partially covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no deductible and no coinsurance, featuring a $35 copay for Medicare-covered exams and no copay for annual routine exams, fittings, and up to two prescription hearing aids with a $500 maximum coverage limit per ear. However, over-the-counter (OTC) hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers vision services with no deductibles and no coinsurance, featuring a copay of $0 to $35 for eye exams and no copay for annual routine exams. Eyewear is also covered with no copay and no coinsurance, up to a combined maximum plan benefit of $300 per year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers preventive dental services like exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental requires a $35 copay and no coinsurance. Comprehensive services like restorative care, endodontics, periodontics, prosthodontics, and oral surgery have no copay and 20% to 50% coinsurance up to a $1,500 annual limit, 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 under Aetna Medicare Advantra Enhanced (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs require 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required. Members pay no coinsurance to 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, and a 20% coinsurance for prosthetic devices and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Enhanced (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and lab services feature no copay and no coinsurance, while diagnostic radiological services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
The Aetna Medicare Advantra Enhanced (HMO-POS) plan 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 by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance, though in practice standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day hospital stay is not needed before admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Advantra Enhanced (HMO-POS) with no copay and no coinsurance, offering benefits like chronic illness meals, annual wellness exams, and up to $90 quarterly for over-the-counter items. Acupuncture is not covered under this benefit.
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