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Aetna Medicare Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in San Antonio and Austin Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (HMO) 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 Premier (HMO).
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 Premier (HMO), 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 $3800.00 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 Premier (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy type. For the initial coverage phase, you may pay a $0 copay or 24% - 25% coinsurance for your prescriptions, depending on the tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for hospital stays with copays, outpatient services with varying copays, and emergency services with copays and no coinsurance. Additionally, the plan covers primary care, preventive services, and home health services, often with no copay. This plan also provides coverage for hearing, vision, and dental services, with copays or coinsurance for certain services. Additional benefits include coverage for medical equipment, diagnostic services, and skilled nursing facility stays, as well as over-the-counter items. Some services, such as cardiac rehabilitation and additional hours of home care, are not covered under this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $325 per day for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $300 per day for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric 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 $325 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (HMO) plan, but requires prior authorization. You will have a $100 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO) plan. Ground Ambulance Services have a copay of $285, while Air Ambulance Services have a 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier (HMO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $65 copay and no coinsurance, and Worldwide Emergency Services have varying copays depending on the service, including a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Premier (HMO) plan covers primary care physician services with no copay and chiropractic services with a $20 copay for routine care. Occupational therapy services have a $40 copay, while physician specialist services have a copay between $0 and $35. Mental health and psychiatric services have a $35 copay for both individual and group sessions, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $65. Opioid treatment program services have a $35 copay.
Preventive Services See details
The Aetna Medicare Premier (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered with a plan-specified amount of $1250 per year, and prescription hearing aids (all types) are covered with no copay for two visits per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Aetna Medicare Premier (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and a combined maximum of $245 is covered per year for eyewear.
Dental Services See details
The Aetna Medicare Premier (HMO) plan covers Medicare Dental Services with a $35 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and other dental services with varying coinsurance amounts. Fluoride Treatment, 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, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (HMO) plan, but prior authorization is required. 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 a coinsurance, and Diabetic Equipment with a coinsurance of 0% to 20% and a copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier (HMO) plan, with copays and coinsurance varying by service. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay up to $300, 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 Premier (HMO) 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 Premier (HMO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO) plan, with a copay of $20 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Premier (HMO) plan covers over-the-counter items with no copay, up to a maximum of $60 every three months, and offers nicotine replacement therapy. Acupuncture, meal benefits, and many other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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