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Aetna Medicare Prime Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Plus (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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maricopa County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime Plus (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 Plus (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 Plus (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 $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 Prime Plus (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet the deductible, your costs will vary depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Prime Plus (HMO-POS) plan offers a variety of benefits with varying costs. Hospital stays have copays, while many outpatient services, including primary care, have copays. Emergency services have copays, and ambulance services have copays or coinsurance. This plan includes coverage for hearing, vision, and dental, with no copays for exams. Medical equipment and diagnostic services have coinsurance or copays. Home health services have no copay, and skilled nursing facilities have copays.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Aetna Medicare Prime Plus (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $475 copay for days 1-7, and no copay for days 8-90; Inpatient Hospital Psychiatric has a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Prime Plus (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $185, observation services with a $475 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a copay of $40 for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime Plus (HMO-POS) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Prime Plus (HMO-POS). Ground ambulance services have a $275 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 Prime Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Transportation has a $275 copay; all services have no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services (excluding routine care), a $25 copay for Occupational Therapy Services, and an $85 copay for Physician Specialist Services. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have a 20% coinsurance with a copay between $0 and $85. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, kidney disease education services with 20% coinsurance, and other preventive services that may have a copay depending on the service. Some services like In-Home Safety Assessment, Personal Emergency Response System, and others are not covered.
Hearing Services See details
The Aetna Medicare Prime Plus (HMO-POS) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $1250 per year, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Prime Plus (HMO-POS) plan includes vision services with no copay for eye exams, including routine eye exams and other eye exam services. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, with a combined maximum benefit of $160 per year.
Dental Services See details
The Aetna Medicare Prime Plus (HMO-POS) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, but it has a $1,000 annual maximum. Orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. 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 under the Aetna Medicare Prime Plus (HMO-POS) plan, but require Prior Authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for some services. Diabetic Equipment is covered, with a coinsurance between 0% and 20% for Diabetic Supplies, and no copay or coinsurance for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Prime Plus (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $150, Outpatient X-Ray Services have a $10 copay, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Prime Plus (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 Prime Plus (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 under the Aetna Medicare Prime Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $180. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Prime Plus (HMO-POS) plan does not cover acupuncture, over-the-counter items, or meal benefits. Other services such as an annual wellness exam, screening mammography, gFOBT, and FIT are covered with no copay.
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