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Aetna Medicare Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Pima County. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (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 (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 (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 Premier (HMO-POS) plan has a $590 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail, but have a $12 copay at standard pharmacies and standard mail. For standard generic drugs, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and many preventive services have no copay. Emergency, primary care, and vision services have copays, and hearing aids are covered up to a certain annual limit. This plan includes coverage for ambulance services, home health services, and skilled nursing facilities with copays. Diagnostic and radiological services, along with medical equipment, have copays or coinsurance. However, be aware that some services, like dental and hearing, have annual limits, and certain services like cardiac rehabilitation are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $445 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $370 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. 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 with a copay of $0-$175, observation services with a $445 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (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 the Aetna Medicare Premier (HMO-POS) plan. Ground ambulance services have a $270 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. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Transportation has a $270 copay; there is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Premier (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with a $25 copay. It also covers physician specialist services with a $30 copay, mental health services with a $40 copay, and physical therapy with a $25 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $50.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams with no copay, and other preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, with no copay. Kidney Disease Education Services has a 20% coinsurance.
Hearing Services See details
The Aetna Medicare Premier (HMO-POS) plan covers hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered, with a maximum benefit of $1250.00 per year, and no copay. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $165 per year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,000 every year. Medicare Dental Services have a $30 copay, while other services like oral exams, dental x-rays, cleanings, fluoride treatments, other preventative services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%, and Medicare Part B Insulin Drugs with a $35 copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (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), Prosthetics/Medical Supplies (non-Medicare benefit), and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier (HMO-POS) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $10, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $200, while Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (HMO-POS) plan with no copay and no coinsurance, though 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-POS) plan. While Cardiac Rehabilitation Services are generally covered, specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO-POS) plan, with a copay of $20 for days 1-20, and $214 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
Other Services are not covered, including acupuncture, over-the-counter items, and meal benefits. However, Other 1 and Other 2 are covered with no copay. Other services are also not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others.
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