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Aetna Medicare Prime (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime (HMO-POS) 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 Prime (HMO-POS).
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 Prime (HMO-POS), 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 $2000.00 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 Prime (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you may have your premium reduced.
Additional Benefits
The Aetna Medicare Prime (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have copays or no copay. Many services have no copay, including preventive services, eye exams, dental services, and home health services. The plan also covers emergency services, primary care, hearing exams, vision services, and home infusion services. You will pay a copay or coinsurance for services like ambulance, mental health, and some diagnostic and radiological services. Some services, like skilled nursing facility and dialysis, require prior authorization and may have copays or coinsurance.
Inpatient Hospital See details
The Aetna Medicare Prime (HMO-POS) plan covers inpatient hospital services, including acute and psychiatric care. For inpatient hospital-acute, you will pay a $50 copay for days 1-5, and no copay for days 6-90. Inpatient hospital psychiatric care has no copay, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by this plan. Outpatient hospital services may have a copay between $0 and $50, observation services have a $50 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Prime (HMO-POS). Ground ambulance services have a $325 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Prime (HMO-POS) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $35 copay, and both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, while Worldwide Emergency Transportation has a $325 copay.
Primary Care See details
The Aetna Medicare Prime (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, and physical therapy/speech-language pathology services have no copay, while physician specialist services have a copay between $0 and $10. Mental health and psychiatric services have a $30 copay for individual and group sessions, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $35. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Prime (HMO-POS) plan covers preventive services including an annual physical exam with no copay. This plan also covers additional preventive services such as health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
The Aetna Medicare Prime (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,250 per year, 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 by Aetna Medicare Prime (HMO-POS). Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $160 per year.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay; however, orthodontic services, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,000 maximum plan benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. The plan covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Prime (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is also covered, with a coinsurance for Medicare-covered therapeutic shoes/inserts and a copay for diabetes supplies, and Diabetic Supplies with 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Prime (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Prime (HMO-POS), but the plan does not cover 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. The copay will vary depending on the service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
The "Other Services" benefit for Aetna Medicare Prime (HMO-POS) is partially covered. Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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 are covered with no copay.
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