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Aetna Medicare Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare 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 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 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. Additionally, this plan comes with a Part B Premium reduction of $10.00. You must continue to pay paying your reduced 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 $599.00 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 Plus (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the following costs. For preferred generic drugs, you pay no copay at preferred pharmacies and preferred mail order, while you pay a $12 copay at standard pharmacies and standard mail order. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you pay 24% or 25% coinsurance depending on the drug and pharmacy. 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 Plus (HMO-POS) plan offers comprehensive coverage with a focus on low-cost care. Many essential services, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision exams, and dental services, are covered with no copay. The plan also provides additional benefits such as ambulance services, emergency services, and home health services. This plan includes coverage for prescription hearing aids up to $2000 per year, and covers a wide array of diagnostic and therapeutic services, including home infusion services. The plan also covers skilled nursing facility stays and dialysis services. However, some services like cardiac rehabilitation, personal care services, and certain types of eyewear are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with no copay for Medicare-covered stays. 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, including all Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered with no copay. Outpatient Blood Services also includes an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Plus (HMO-POS) plan, and requires prior authorization. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Plus (HMO-POS), including ground and air ambulance services. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year, but 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 by the Aetna Medicare Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $140 copay with no coinsurance, while Worldwide Emergency Transportation has a $275 copay with no coinsurance. Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
The Aetna Medicare Plus (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 and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Occupational therapy services, mental health specialty services, psychiatric services, and opioid treatment program services may have a copay of $0. Additional telehealth benefits have a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education and wigs for hair loss related to chemotherapy. The plan also covers additional services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Aetna Medicare Plus (HMO-POS) covers hearing exams and fitting/evaluation for hearing aids with no copay, and covers prescription hearing aids (all types) with no copay up to a maximum of $2000 per year, but prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered. Routine hearing exams are covered once per year with no copay.
Vision Services See details
Vision services under the Aetna Medicare Plus (HMO-POS) plan include eye exams and routine eye exams with no copay, as well as other eye exam services with no copay. Eyewear is not covered.
Dental Services See details
Dental services include a $2,250 annual maximum benefit, with no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Orthodontic services are covered under diagnostic and preventive dental services, and the plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
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 by the Aetna Medicare Plus (HMO-POS) plan. There is a 20% coinsurance for dialysis services, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Plus (HMO-POS) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance between 20% and 20%, and Medical Supplies have no coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have no copay, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare 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 under the Aetna Medicare Plus (HMO-POS) plan. A doctor's referral is required for these services, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $50 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Plus (HMO-POS) plan covers acupuncture with no copay. Other services such as Over-the-Counter (OTC) Items, meal benefits, 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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