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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 Alameda and San Francisco 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.
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 $3400.00 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 an Enhanced Alternative drug benefit. The plan has a $590 deductible. In the initial coverage phase, after you pay your deductible, you will pay either a copay or coinsurance based on the drug tier and pharmacy. Preferred Generic drugs have no copay if purchased at a preferred pharmacy or through the mail. Standard Generic drugs have 24% coinsurance. Preferred Brand and Non-Preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Plus (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find no copays for many services, such as primary care, preventive services, hearing and vision exams, and dental cleanings. The plan also covers ambulance services, emergency care, and skilled nursing facilities, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90, and for Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, 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 have a copay between $0 and $125, while observation services, ambulatory surgical center services, outpatient individual and group substance abuse sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Plus (HMO-POS) plan, requiring prior authorization. There is no copay for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare Plus (HMO-POS) plan covers ambulance and transportation services, including ground and air ambulance, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay and are limited to 12 one-way trips per year using rideshare services, bus/subway, or medical transport. 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 Aetna Medicare Plus (HMO-POS). Emergency Services and Worldwide Emergency Coverage have a $140 copay and no coinsurance. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Transportation has a $325 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, speech-language pathology services, individual and group mental health and psychiatric sessions, and other health care professional services have no copay. Additional telehealth benefits have a 20% coinsurance and no copay.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, and no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Other services such as 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. Kidney Disease Education Services have a 20% coinsurance, and Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) are covered with no copay.
Hearing Services See details
The Aetna Medicare Plus (HMO-POS) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and routine hearing exams and prescription hearing aids (all types) with no copay. Prescription hearing aids have a maximum benefit of $2000 per year, per ear. However, prescription hearing aids for the inner ear, outer ear, and over the ear, along with OTC hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams with no copay and routine eye exams with no copay, once per year. Eyewear is also covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Aetna Medicare Plus (HMO-POS) plan offers a dental services benefit with a $1,100 annual maximum. Preventive services like oral exams, X-rays, cleanings, and fluoride treatments have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and adjunctive general services 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 Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Plus (HMO-POS) with prior authorization required. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies, and Diabetic Equipment with a coinsurance between 0% and 20% for Diabetic Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services and radiological services requiring prior authorization and a doctor referral. Diagnostic Procedures/Tests and Outpatient X-Ray Services have no copay, while Lab Services have no copay. Therapeutic Radiological Services have a copay of at most $60.00, while 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 covered with a doctor referral, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Plus (HMO-POS) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $75.
Other Services See details
The Aetna Medicare Plus (HMO-POS) plan covers acupuncture with no copay, and also covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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