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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 Riverside and San Bernardino 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 $30.00. 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 the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and preferred mail order. Standard generic drugs have a 24% coinsurance. Preferred and non-preferred brand drugs have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Plus (HMO-POS) plan offers comprehensive coverage with no copays for many services. This includes inpatient hospital stays, outpatient services, partial hospitalization, primary care, preventive services, hearing and vision exams, dental services, home health services, and skilled nursing facility stays for the first 20 days. The plan also covers ambulance and transportation services, emergency services, and home infusion services, with varying copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization, and Inpatient Hospital-Acute includes enhanced benefits. There is no copay for Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and additional days for Inpatient Hospital-Acute are covered with no copay per day, 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 services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have no copay.
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 under the Aetna Medicare Plus (HMO-POS) plan. 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.
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 have a $140 copay, while Worldwide Emergency Transportation has a $275 copay, and Urgently Needed Services has no copay. There is no coinsurance for any of these services.
Primary Care See details
Under the Aetna Medicare Plus (HMO-POS) plan, primary care physician services, chiropractic services, occupational therapy, 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 are covered. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, individual and group sessions for mental health and psychiatric services, and other health care professional services have no copay, while additional telehealth benefits have a 20% coinsurance and no copay.
Preventive Services See details
The Aetna Medicare Plus (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all of which have no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees are not covered.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, 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 with 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 partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
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, all with no copay. However, the plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with no coinsurance, and Diabetic Equipment with a 0-20% coinsurance for Diabetic Supplies and a copay for Medicare-covered Diabetes Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Plus (HMO-POS) plan. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services have no copay. Therapeutic Radiological Services have a copay of $60.00, and Diagnostic Radiological Services have a copay of at most $0.00.
Home Health Services See details
Home Health Services are covered by 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 by the Aetna Medicare Plus (HMO-POS) plan. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Plus (HMO-POS) plan, with a $0 copay for days 1-20, and a $50 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
Other Services include acupuncture with no copay, while over-the-counter items, meal benefits, and several other services are not covered. Specifically, this plan does not cover 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.
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