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Aetna Medicare Prime Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Value 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 Prime Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Los Angeles County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime Value 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 Prime Value 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 Prime Value 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 $450.00 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 $299.00 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 Prime Value Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $450 deductible for prescription drugs. During the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and a $12 copay at standard pharmacies. You will enter the catastrophic coverage phase once your total drug costs reach $2000. In the catastrophic coverage phase, you pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Prime Value Plus (HMO-POS) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, primary care, preventive services, and hearing and vision exams. The plan also provides additional benefits such as dental coverage, home health services, and coverage for medical equipment. This plan includes a $140 copay for emergency services and a $275 copay for ground ambulance services, but also offers no-copay coverage for many other services. There is a $2,000 maximum benefit per year for dental services, and a $1250 maximum annual benefit for prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay for a Medicare-covered stay. 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 outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers ambulance and transportation services. Ground ambulance services have a $275 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay for up to 12 one-way trips per year, using rideshare services, bus/subway, or medical transport, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Aetna Medicare Prime Value Plus (HMO-POS), with a $140 copay and no coinsurance. Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Services are covered, with a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services (with no copay), occupational therapy, physician specialist services, mental health specialty services (with no copay), other health care professional services (with no copay), psychiatric services (with no copay), physical therapy and speech-language pathology services (with no copay), additional telehealth benefits (with no copay and 20% coinsurance), and opioid treatment program services (with no copay). Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other 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, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay; however, 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, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, Counseling Services, and Support for Caregivers of Enrollees are not covered. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are included with this plan. The plan offers a combined maximum amount of $355.00 for all eyewear every year.
Dental Services See details
Dental Services include coverage for 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 with no copay, but orthodontic services, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a $2,000 maximum benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, and coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics/medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has no copay and a 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have at most no copay, and Therapeutic Radiological Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime Value 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's referral, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The copay for covered services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Value 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.
Other Services See details
Other services include acupuncture and over-the-counter (OTC) items. Acupuncture has no copay, and OTC items have no copay, with a maximum plan benefit coverage amount of $120 every three months. Other services such as meal benefits, and several others are not covered.
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