A non-government entity
Aetna Medicare Signature Care (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature Care (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature Care (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Care (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Rio Grande Valley Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature Care (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 Signature Care (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 Signature Care (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 $500.00 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 $4150.00 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 Signature Care (HMO) prescription drug plan features an annual drug deductible of $500. Under this plan, members pay no copay for Tier 1 preferred generic and Tier 2 generic medications when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options require a copay of $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply length. For brand-name and specialty medications, costs transition to coinsurance percentages instead of flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy types. Tier 5 specialty drugs carry a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Signature Care (HMO) plan offers robust medical coverage with no copay for primary care visits, annual physicals, and home health services. For specialized medical needs, members pay a $10 to $30 copay for specialist visits, while inpatient acute hospital stays require a $390 daily copay for the first six days. Emergency care is accessible with a $150 copay, which is waived upon immediate admission, alongside outpatient services featuring low to no copays. This plan also includes valuable everyday health benefits, offering routine vision exams and annual preventive dental cleanings with no copay or coinsurance. Members receive up to $1,000 per ear annually for prescription hearing aids and a $150 annual allowance for eyewear, both with no copay. Additionally, the plan provides diagnostic lab services and X-rays with no copay, plus a $30 quarterly reimbursement for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Signature Care (HMO) with no coinsurance, though prior authorization is required. Acute stays require a $390 daily copay for days 1 through 6 and no copay for remaining days, while psychiatric stays require a $375 daily copay for days 1 through 5 and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature Care (HMO) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $390 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under Aetna Medicare Signature Care (HMO) with a copay of either $100.00 or $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature Care (HMO) covers ambulance services with prior authorization, requiring a $260 copay plus coinsurance for ground transport and a 20% coinsurance plus a copay for air transport. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature Care (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum plan benefit with no coinsurance and copays ranging from $150 to $260.
Primary Care See details
Aetna Medicare Signature Care (HMO) features primary care physician visits with no copay and no coinsurance, while specialist visits require a $10 to $30 copay and no coinsurance. Most physical, occupational, mental health, and psychiatric therapy services have a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered. Telehealth benefits are also available with a $0 to $65 copay and 20% coinsurance.
Preventive Services See details
Preventive Services under the Aetna Medicare Signature Care (HMO) are partially covered, offering annual physicals, health education, and select screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Supplemental benefits such as in-home safety assessments, medical nutrition therapy, weight management programs, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered under the Aetna Medicare Signature Care (HMO) plan, featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear annually, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Signature Care (HMO) covers vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam per year and follow-up diabetic eye exams. Eyewear is also covered with no copay or coinsurance up to a combined maximum plan benefit of $150 annually for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Signature Care (HMO) partially covers dental services, offering preventive care such as exams, cleanings, and x-rays with no copay and no coinsurance, and Medicare-covered dental with a $30 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance, but other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature Care (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs are covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Signature Care (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Signature Care (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copays. Coinsurance for these covered benefits ranges from no coinsurance up to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature Care (HMO), requiring prior authorization for all services and referrals for diagnostics. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $40 copay for tests, while radiological services offer X-rays with no copay and therapeutic services with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Signature Care (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Signature Care (HMO) plan, as all sub-services are excluded from coverage in practice, meaning there is no plan-covered copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Signature Care (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $190 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature Care (HMO) covers select other services with no copay and no coinsurance, including annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $30 every three months in over-the-counter items via reimbursement. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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