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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 Central 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 $18.00. 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:
Sign up for Aetna Medicare Advantra Premier (HMO-POS)
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Drug Coverage
The Aetna Medicare Advantra Premier (HMO-POS) plan has an "Enhanced Alternative" drug benefit. You will pay a deductible of $590 before your drug coverage begins. Once your deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will have no copay for preferred generic drugs at a preferred pharmacy or preferred mail order, and 24% coinsurance for standard generic drugs.
Additional Benefits
The Aetna Medicare Advantra Premier (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays between $0 and $250. The plan provides no copay for many services, including primary care physician visits, routine eye exams, and many dental services. The plan also includes coverage for emergency services, hearing and vision services, and home health services, as well as coverage for OTC items up to a certain amount. Some services, like ambulance and some diagnostic services, have coinsurance. However, it's important to note that certain services like Cardiac Rehabilitation Services, are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $450 copay per admission, and additional days have no copay, while Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $350 copay for days 1-5, and no copay for days 6-90, while additional days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 $45 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Advantra Premier (HMO-POS) plan, and requires prior authorization. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Premier (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $260 copay, and air ambulance services have 20% coinsurance; however, both copays and coinsurance are waived if admitted to the hospital. Transportation Services to a plan-approved health-related location are covered with no copay, and limited to 6 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $260 copay; all have no coinsurance.
Primary Care See details
For the Aetna Medicare Advantra Premier (HMO-POS) plan, primary care physician services have no copay, chiropractic services have a $15 copay, occupational therapy services have a $35 copay, physician specialist services have a $35 copay, and physical therapy and speech-language pathology services have a $35 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, and opioid treatment program services all have varying copays depending on the service. Additional telehealth benefits have a 20% coinsurance and a copay that ranges from $0 to $45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services with varying copays. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, each with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids 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 and eyewear. Routine eye exams have no copay, while other eye exams may have a copay between $0 and $35. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $330 per year.
Dental Services See details
Dental services include a $35 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. This plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Advantra Premier (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 under the Aetna Medicare Advantra Premier (HMO-POS) plan. This benefit requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0% to 20% coinsurance. Diabetic Supplies have 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a maximum copay of $250 and Outpatient X-Ray Services have a copay of $25. Therapeutic Radiological Services have a minimum coinsurance of 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 not covered by the Aetna Medicare Advantra Premier (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Premier (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Advantra Premier (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $90 every three months. Meal benefits and other services, such as annual wellness exams, screening mammography, gFOBT, and FIT, are also covered with no copay. However, 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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