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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 Kern County. 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 $26.00. 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 $2000.00 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 pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Plus (HMO-POS) plan offers a variety of benefits with a focus on no copays for many services. This includes inpatient and outpatient hospital services, primary care, preventive services like annual physicals, and vision and dental care. The plan also covers ambulance services, with a copay for ground and coinsurance for air, and emergency services with a copay. Hearing services, hearing aids, and home health services are covered, as are home infusion bundled services, skilled nursing facilities, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits for the Aetna Medicare Plus (HMO-POS) plan include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for a Medicare-covered stay and no coinsurance. 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 services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have no copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Plus (HMO-POS) plan, with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by 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, and Transportation Services to any other 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 Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, 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
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. The coinsurance for additional telehealth benefits is 20%.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as coverage for Medicare-covered services with no copay. Other services like Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies have no copay, with Wigs for Hair Loss Related to Chemotherapy having a maximum coverage of $400 per year. Kidney Disease Education Services have a 20% coinsurance. Some services, such as In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids are covered up to $2,000 per year, and all types of prescription hearing aids have no copay, limited to two visits per year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Plus (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $180 every year.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum. 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 are covered with no copay. Orthodontic services are covered under Diagnostic and Preventive Dental, but 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 Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with 0-20% coinsurance. Prior authorization is required for this benefit.
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 for these services.
Medical Equipment See details
Medical Equipment benefits are covered under 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 20% coinsurance, Medical Supplies have no coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services, with prior authorization and a doctor referral required for diagnostic services. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a copay of up to $60, while Outpatient X-Ray Services have no copay.
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, but the plan does not cover the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Plus (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Aetna Medicare Plus (HMO-POS) covers acupuncture with no copay, and also covers other services including annual wellness exams, screening mammography, gFOBT and FIT with no copay. Over-the-counter 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.
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