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Aetna Medicare Premier II (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier II (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 II (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier II (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Houston. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier II (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 II (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 II (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 $9350.00 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 II (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you pay no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you pay 22% or 25% coinsurance, depending on the tier. After your total yearly drug costs reach $2000, you will pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Premier II (HMO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while outpatient services, including primary care, have no copay for many services. The plan also includes coverage for preventive services, hearing, vision, and dental, with no copays for routine exams and cleanings. Emergency services, ambulance, and home health services are covered, with copays or coinsurance depending on the specific service. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services. This plan also offers a variety of other services, including OTC items, with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $395 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $300 for days 1-6 and no copay for days 7-90. 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 all outpatient hospital services and outpatient substance abuse services. Outpatient hospital services have a copay between $0 and $350, and observation services have a $395 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier II (HMO) plan, requiring prior authorization, with an $80 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier II (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance, and 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 under the Aetna Medicare Premier II (HMO) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $300 copay; all have no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance.
Primary Care See details
The Aetna Medicare Premier II (HMO) plan covers Primary Care Physician services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a copay between $0 and $50, and Physical Therapy and Speech-Language Pathology Services with a $45 copay. Mental Health and Psychiatric Services have a $45 copay for individual and group sessions, while Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. The plan does not cover Podiatry Services, and Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam, with no copay. Other 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; however, the plan does not cover In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, or Support for Caregivers of Enrollees. The plan also covers Kidney Disease Education Services with 20% coinsurance, and 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, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $35 copay, routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum benefit of $500 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
The Aetna Medicare Premier II (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. There is a combined maximum benefit of $160.00 every year for eyewear.
Dental Services See details
Dental services are covered, including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 20%-50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. 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 under the Aetna Medicare Premier II (HMO) plan, and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. For Durable Medical Equipment, there is a coinsurance of 0-20% and no copay. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered, including diagnostic procedures/tests with a copay between $0 and $50, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier II (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A doctor's referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier II (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier II (HMO) plan's Other Services benefit includes coverage for Over-the-Counter (OTC) Items with no copay. Acupuncture, Meal Benefit, 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. Other 1 and Other 2 services have no copay.
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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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