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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 Fresno 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 $20.00. 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 $2900.00 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 is met, you will pay the following costs for your prescriptions. For preferred generic drugs, you pay no copay at preferred pharmacies and mail order, or a $12 copay at standard pharmacies. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Plus (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first seven days, while outpatient services and primary care have no copay. Emergency services have a $140 copay, and ambulance services have a $150 copay for ground transport. Preventive, hearing, vision, and dental services are covered with no copay, including hearing aids up to $1250 per year. The plan also covers medical equipment and home health services with no copay, while dialysis services have a 20% coinsurance. Skilled nursing facilities have no copay for the first 20 days, and a $75 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-7, and no copay for days 8-90. 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. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $100, while observation services, ambulatory surgical center services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services have no copay.
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 Aetna Medicare Plus (HMO-POS), with a $150 copay for ground ambulance services and a 20% coinsurance for air ambulance services. 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 have a $140 copay, while Worldwide Emergency Transportation has a $150 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, and routine chiropractic care have no copay. Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have no copay, while additional telehealth benefits have a 20% coinsurance and no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services such as health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, and kidney disease education services. Kidney disease education services have a 20% coinsurance. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit are covered with no copay. Several services, including in-home safety assessments, personal emergency response systems, and therapeutic massage, are not covered.
Hearing Services See details
Aetna Medicare Plus (HMO-POS) covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, up to a maximum of $1250 per year, per ear.
Vision Services See details
Aetna Medicare Plus (HMO-POS) covers vision services, including eye exams and eyewear, with no copay. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $140.00 per year.
Dental Services See details
The Aetna Medicare Plus (HMO-POS) plan covers a variety of dental services, including 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, it does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a maximum plan benefit of $1300 per year for other dental services.
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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Plus (HMO-POS) with prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Plus (HMO-POS) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies. Diabetic equipment is covered, 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 are covered, including diagnostic procedures/tests and lab services with no copay, diagnostic radiological services with a copay up to $50, therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required for all diagnostic services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Plus (HMO-POS) plan with no copay and no coinsurance. However, 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $75 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays 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. The plan also covers annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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