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Aetna Medicare Advantra Philly Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Philly Prime (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 Philly Prime (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Philly Prime (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Philadelphia County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Philly Prime (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 Philly Prime (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 Philly Prime (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 $6900.00 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 Philly Prime (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay for your drugs based on the tier and pharmacy you use. For example, in the initial coverage phase, preferred generic drugs have no copay when using a preferred pharmacy or mail order, but have a $12 copay at a standard pharmacy. Standard generic drugs have 24% coinsurance.
Additional Benefits
The Aetna Medicare Advantra Philly Prime (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like primary care visits have a copay. Many preventive services, such as an annual physical exam and vision services like routine eye exams, have no copay. Additional benefits include coverage for hearing aids, dental services with no copay for many services, and home health services with no copay. The plan also covers ambulance and emergency services with copays, and offers coverage for other services like OTC items, and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0 to $325, observation services have a copay of $325, and ASC services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse services have a copay of $45.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up 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, and Worldwide Emergency Services are covered by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Primary care services include no copay for primary care physician services and $15 copay for chiropractic services and routine chiropractic care. Specialist visits have a $45 copay, and occupational therapy and physical therapy have a $35 copay. Mental health and psychiatric services have a $45 copay for individual and group sessions, and podiatry services have a $45 copay for Medicare-covered podiatry services and routine foot care. Other health care professionals have a copay between $0 and $45, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services also have a $45 copay.
Preventive Services See details
The Aetna Medicare Advantra Philly Prime (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. This plan also covers additional preventive services, including health education, nutritional/dietary benefits, wigs for hair loss due to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, 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 Services include hearing exams with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a $500 plan-specified amount per year, but OTC hearing aids, and some prescription hearing aid types are not covered.
Vision Services See details
The Aetna Medicare Advantra Philly Prime (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $45 and eyewear with no copay, up to a combined maximum of $350 per year. Routine eye exams and other eye exam services have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Dental services include a $45 copay for Medicare dental services, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1,500 per year for other dental services.
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 a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Philly Prime (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 no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment. The plan does not cover Durable Medical Equipment for use outside the home. For Diabetic Supplies, there is no copay and 0-20% coinsurance. For Diabetic Therapeutic Shoes/Inserts, there is 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of at most $250.00, and Outpatient X-Ray Services have a $20.00 copay; Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Philly Prime (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 by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for the covered Cardiac Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Philly Prime (HMO-POS) plan. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Advantra Philly Prime (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $75 every three months. The plan also covers a Meal Benefit with no copay, and other services like annual wellness exams, screening mammography, gFOBT, and FIT with no copay. Acupuncture, Dual Eligible SNPs, 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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