A non-government entity
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 Houston and Surrounding Areas. 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 $6350.00 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 an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order pharmacies. You will enter the catastrophic coverage phase once your total drug costs reach $2000.00, at which point you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO) plan provides comprehensive coverage with a variety of benefits. You'll find that many services have no copay, including primary care visits, eye exams, and preventive services like annual physicals. The plan also offers coverage for inpatient and outpatient services, emergency care, and home health services, with varying copays and coinsurance amounts depending on the service. Additional benefits include coverage for hearing and vision services, with no copays for eye exams and eyewear, and a copay for hearing exams. Dental services have a copay for Medicare dental services, and no copay for oral exams, dental x-rays, and cleaning. The plan also covers medical equipment, diagnostic services, and skilled nursing facility stays, each with its own copay or coinsurance structure.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered under the Aetna Medicare Premier (HMO) plan. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $300 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services with a $300 copay. Also covered are ambulatory surgical center (ASC) services and outpatient blood services, both with no copay, and outpatient substance abuse services, with a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (HMO) plan, but requires prior authorization, and has a copay of $85.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Aetna Medicare Premier (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, and physician specialist services with a copay between $0 and $35. Mental health and psychiatric services have a $35 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55, and Opioid Treatment Program Services have a $35 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Premier (HMO) plan covers preventive services, including an annual physical exam with no copay, and other preventive services with varying copays. The plan also covers wigs for hair loss related to chemotherapy, Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Medicare-covered 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 exams are covered with a $35 copay and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams and eyewear have no copay, and the plan covers one routine eye exam per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay. There is a combined maximum plan benefit of $305 per year for all eyewear.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed) and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%. Orthodontic services have a maximum plan benefit of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. 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, 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 0-20%, Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance for Medicare-covered items, and Diabetic Equipment. Diabetic Supplies have a coinsurance of 0-20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
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 under the Aetna Medicare Premier (HMO) plan. This includes Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Premier (HMO), but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Aetna Medicare Premier (HMO) covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $60.00 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, and several 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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