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Aetna Medicare Preferred Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred 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 Preferred Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred 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 Preferred 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 Preferred 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 Preferred 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $399.00 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 Preferred Plus (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Preferred Plus (HMO-POS) plan offers comprehensive coverage with many services at no copay. This plan includes no copay for inpatient and outpatient hospital stays, primary care, preventive services, hearing and vision exams, dental services, durable medical equipment, and home health services. The plan also offers additional benefits such as transportation services, hearing aids, and a yearly allowance for eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. There is no copay for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also 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 with no copay. Outpatient blood services also include a waived three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Preferred Plus (HMO-POS) plan, with no copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Preferred Plus (HMO-POS), including ground ambulance services with a $275 copay and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Preferred 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.
Primary Care See details
The Aetna Medicare Preferred Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care, chiropractic, specialist, mental health, psychiatric, and physical therapy all have no copay. Occupational therapy and telehealth services have no copay, but telehealth has a 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, such as Health Education, and Wigs for Hair Loss Related to Chemotherapy, are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
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 with a maximum benefit of $1250 per year, and all types of prescription hearing aids are covered with no copay. OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay. The plan covers up to $275 annually for combined eyewear.
Dental Services See details
Dental Services are covered, 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1,250 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Preferred 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 by the Aetna Medicare Preferred Plus (HMO-POS) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with no coinsurance. The plan also covers Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Preferred Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have no copay, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Preferred 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 Preferred Plus (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Preferred Plus (HMO-POS), but require prior authorization. There is no 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 are not covered.
Other Services See details
Other services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay, while OTC items have no copay and a maximum benefit coverage amount of $75 every three months. Meal benefits, 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, 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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