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Aetna Medicare Premier 3 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier 3 (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 Premier 3 (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier 3 (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier 3 (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 Premier 3 (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 Premier 3 (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 $4500.00 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 3 (HMO-POS) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies or mail order, and a $12.00 copay at standard pharmacies. For all other drugs, you pay 24% or 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 3 (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for primary care visits, preventive services, hearing and vision exams, and many dental services. The plan also covers emergency services and ambulance services with copays, and offers home health services with no copay or coinsurance. This plan provides additional benefits like hearing aids, eyewear, and dental services, all with specific coverage limits. Prescription hearing aids are covered with a maximum benefit of $1250 per year. Diagnostic, radiological, and home infusion services are covered, with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, there is a $315 copay for days 1-7, and no copay for days 8-90; Additional Days for Inpatient Hospital-Acute has no copay. Inpatient Hospital Psychiatric has a $370 copay for days 1-5, and no copay for days 6-90. 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 outpatient hospital services with a copay of $0-$400, observation services with a $400 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. These services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Premier 3 (HMO-POS) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier 3 (HMO-POS) plan. Ground ambulance services have a $265 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, and Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
The Aetna Medicare Premier 3 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a $35 copay. Mental health, psychiatric, and opioid treatment services have $40 copays for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth services have a 20% coinsurance and a copay between $0 and $50.
Preventive Services See details
Preventive services include Medicare-covered services with no copay, annual physical exams with no copay, and additional preventive services. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies with no copay. Kidney Disease Education Services have a 20% coinsurance, and other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
The Aetna Medicare Premier 3 (HMO-POS) plan covers hearing exams with no copay and routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $1250 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, routine eye exams, and other eye exam services with no copay, and eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, up to a combined maximum of $205 per year.
Dental Services See details
The Aetna Medicare Premier 3 (HMO-POS) plan covers Medicare Dental Services with a $35 copay, and offers other dental services with a $750 maximum benefit per year, including 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, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has 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 by the Aetna Medicare Premier 3 (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Premier 3 (HMO-POS), including Durable Medical Equipment (DME) with a 0% to 20% coinsurance, and Prosthetics/Medical Supplies and Diabetic Equipment with varying coinsurance. Durable Medical Equipment for use outside the home is not covered, and authorization is required for some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Premier 3 (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services may have a copay up to $175, while Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier 3 (HMO-POS) 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 by the Aetna Medicare Premier 3 (HMO-POS) plan. 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, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier 3 (HMO-POS) plan, with prior authorization required. You will have no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier 3 (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. The plan also covers Other 1 and Other 2 services with no copay. Acupuncture, Dual Eligible SNPs, 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.
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