A non-government entity
Aetna Medicare Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Alameda and San Francisco Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (HMO) 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 Signature (HMO).
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 Signature (HMO), 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 $615.00 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 $3900.00 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 Signature (HMO) plan features an annual prescription drug deductible of $615.00 before the initial coverage phase begins. During this initial phase, you will have no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard options charge a $12.00 copay. For Tier 2 standard generics, you will pay a 24% coinsurance regardless of the pharmacy type you choose. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both carry a 25% coinsurance through all pharmacy and mail-order channels. Once your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, those who qualify for the low-income subsidy can reduce their Part D premium cost to $0.00.
Additional Benefits
The Aetna Medicare Signature (HMO) plan offers affordable coverage for core medical needs, featuring no copay or coinsurance for primary care, specialist visits, and routine preventive services. For hospital stays, members pay a $325 daily copay for the first five days of inpatient care, while outpatient services range from no copay up to a $325 copay. Emergency room visits require a $150 copay, which is waived if admitted, while urgent care visits have no copay. This plan also includes key supplemental benefits, providing routine dental, vision, and hearing exams with no copay or coinsurance. Members receive a $100 annual eyewear allowance and up to $500 per ear for prescription hearing aids, while comprehensive dental services require a 20% to 50% coinsurance. Durable medical equipment and dialysis require up to 20% coinsurance, whereas home health services are covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Signature (HMO) with a $325 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Signature (HMO) with no coinsurance, featuring copays ranging from no copay for blood services up to $325 per stay for observation services. Patients will also pay a $0 to $250 copay for outpatient hospital services, a $200 copay for ambulatory surgical center visits, and a $40 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (HMO) with copays ranging from no copay to $180 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Signature (HMO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $325 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Signature (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are offered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $250,000 with copays ranging from $150 to $325 and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by Aetna Medicare Signature (HMO), offering no copay and no coinsurance for primary care, specialist, physical therapy, and occupational therapy visits. Mental health, psychiatric, and opioid treatment sessions require a $40 copay and no coinsurance, while telehealth services have a 20% coinsurance and a copay ranging from no copay up to $40. However, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by Aetna Medicare Signature (HMO), featuring no copay and no coinsurance for annual physical exams, health education, and routine screenings. Kidney disease education requires a 20% coinsurance and no copay, while additional benefits are only partially covered, excluding services like in-home safety assessments, weight management, alternative therapies, and nutritional benefits.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Signature (HMO), which features routine hearing exams, fittings, and prescription hearing aids with no copays or coinsurance. While the plan provides up to $500 per ear annually for prescription hearing aids, OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (HMO) covers vision services with no copays and no coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. The plan also provides a $100 combined annual allowance for eyewear, such as eyeglasses, contact lenses, and upgrades, with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (HMO), offering preventive care such as oral exams, cleanings, and x-rays with no copay or coinsurance. Comprehensive treatments like restorative care, endodontics, and periodontics are covered with a 20% to 50% coinsurance and no copay, up to a $400 annual limit, while fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (HMO) with prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Signature (HMO) covers dialysis services with a 20% coinsurance and no copay, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (HMO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with prior authorization required. These benefits feature no copay, with coinsurance ranging from no coinsurance up to 20% depending on the specific item.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (HMO) covers diagnostic and radiological services with no coinsurance and no copay for lab services, diagnostic tests, diagnostic radiology, and outpatient X-rays. A $60 copay applies to therapeutic radiological services, and prior authorization or doctor referrals are required for these benefits.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Signature (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Signature (HMO) plan, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Signature (HMO), requiring prior authorization and featuring no coinsurance, with no copay for days 1 to 20 and a $75 daily copay for days 21 to 100. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Signature (HMO), offering no copay and no coinsurance for covered services like annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Acupuncture, over-the-counter (OTC) items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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