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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 Hidalgo County. 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 $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 Premier (HMO) plan has a $590.00 deductible for prescription drugs. After the deductible, you'll pay for your prescriptions based on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at preferred pharmacies or through mail order. Standard generic drugs have a 24% coinsurance, and preferred and non-preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO) plan offers a variety of benefits with varying costs. You'll find no copays for primary care visits, preventive services, eye exams, eyewear, oral exams, dental x-rays, cleanings, home health services, and over-the-counter items (up to $60 every three months). Hospital stays have copays ranging from $0 to $395, outpatient services have copays between $0 and $200, and emergency services have a $140 copay. Additional benefits include coverage for hearing aids (with a $1250 annual maximum), and a $25 copay for hearing exams. Dental services have a $25 copay for Medicare-covered services. The plan also covers ambulance services, with a $270 copay for ground transport and 20% coinsurance for air transport. There are also some coinsurances for services like dialysis, durable medical equipment, and various therapies, so be sure to review the details of each service.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, there is a $375 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital Psychiatric and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Aetna Medicare Premier (HMO) plan. Outpatient Hospital Services have a copay between $0 and $200, Observation Services have a $200 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions. 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. The copay for this benefit is $100.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Premier (HMO), with prior authorization required for all ambulance services. Ground ambulance services have a copay of $270.00, and air ambulance services have a 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the Aetna Medicare Premier (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $65 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $270 copay, with no coinsurance for any service.
Primary Care See details
The Aetna Medicare Premier (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay (excluding routine care), occupational therapy with a $30 copay, and physician specialist services with a copay between $10 and $25. Mental health specialty services have a $25 copay for both individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $65, and opioid treatment program services with a $25 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and also cover additional services like health education, wigs for hair loss due to chemotherapy, additional sessions of smoking cessation counseling, fitness benefits, and remote access technologies, all with no copay. Kidney disease education services have a 20% coinsurance, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have no copay. In-home safety assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and Home-Based Palliative Care are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $1250 per year, but prescription hearing aids - inner ear, outer ear, and over the ear, along with OTC hearing aids, are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $320 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, Oral Exams with no copay, Dental X-Rays with no copay, Prophylaxis (Cleaning) with no copay, Restorative Services with 20% to 50% coinsurance, Adjunctive General Services with 20% to 50% coinsurance, Endodontics with 20% coinsurance, Periodontics with 20% to 50% coinsurance, Prosthodontics, removable with 50% coinsurance, and Prosthodontics, fixed with 50% coinsurance; however, Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan also covers Orthodontic Services with a $2,500 maximum benefit coverage.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Premier (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required for coverage.
Medical Equipment See details
The Aetna Medicare Premier (HMO) plan covers durable medical equipment with a coinsurance between 0% and 20%, and requires authorization. Prosthetic devices are covered with a 20% coinsurance, and medical supplies have a coinsurance of 0% to 20%. Diabetic equipment is covered, with a coinsurance for Medicare-covered therapeutic shoes or inserts and a copay for Medicare-covered diabetes supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Premier (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $40, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, Therapeutic Radiological Services have a coinsurance of at least 20%, 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. However, 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. You will have a $20 copay for days 1-20, and a $200 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required.
Other Services See details
The Aetna Medicare Premier (HMO) plan's "Other Services" benefit covers over-the-counter items with no copay, up to a maximum of $60 every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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