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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 2026, 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 Kern, Riverside and San Bernardino Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
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 $11.50. 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 $599.00 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 features an annual prescription drug deductible of $615.00. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs at preferred retail pharmacies or through preferred mail order, while standard options require a $12.00 copay. Additionally, individuals qualifying for the low-income subsidy may see their Part D premium reduced to $11.50. For other drug tiers during the initial coverage phase, you will pay a 22% coinsurance for Tier 2 standard generics and a 25% coinsurance for Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The Aetna Medicare Prime Value Plus (HMO-POS) plan offers comprehensive medical coverage, featuring no copay and no coinsurance for inpatient hospital stays, outpatient services, and primary or specialist care visits. Emergency services are covered with a $150 copay that is waived upon hospital admission, while urgently needed care requires no copay. Additionally, members can access up to 12 free one-way transportation trips per year to plan-approved health locations. For routine wellness, this plan provides no-copay coverage for annual physicals, routine eye exams, and dental cleanings, alongside a $200 annual eyewear allowance. Hearing exams and prescription hearing aids also feature no copay, with coverage up to $1,250 per ear annually. For specialized recovery, skilled nursing facility stays require no copay for the first 20 days, followed by a $50 daily copay for days 21 through 100.
Inpatient Hospital See details
Aetna Medicare Prime Value Plus (HMO-POS) partially covers inpatient hospital services with no copay and no coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Prime Value Plus (HMO-POS) with no copay and no coinsurance for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, which also feature no deductible.
Partial Hospitalization See details
Aetna Medicare Prime Value Plus (HMO-POS) covers partial hospitalization benefits, though prior authorization is required. Depending on the specific service, you will pay either no copay or a $180 copay, and there is no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Prime Value Plus (HMO-POS) covers ambulance services with a $275 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Prime Value Plus (HMO-POS) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with copays ranging from $150 to $275.
Primary Care See details
Aetna Medicare Prime Value Plus (HMO-POS) offers partially covered Primary Care benefits, as podiatry services are not covered. Covered services like primary care, specialist, and therapy visits feature no copay and no coinsurance, while additional telehealth benefits require a 20% coinsurance and no copay.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Prime Value Plus (HMO-POS), featuring annual physicals, health education, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Prime Value Plus (HMO-POS) partially covers hearing services, offering routine exams, fittings, and prescription hearing aids with no copay and no coinsurance, up to a $1,250 annual maximum per ear. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Prime Value Plus (HMO-POS) covers vision services with no copays, no deductibles, and no coinsurance for routine eye exams and eyewear. Members receive one routine exam annually and a $200 yearly maximum allowance for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime Value Plus (HMO-POS), which features no copay and no coinsurance for Medicare dental services, oral exams, cleanings, and x-rays. Other covered treatments require no copay and 20% to 50% coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Prime Value Plus (HMO-POS) and require prior authorization. Covered 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 of no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Prime Value Plus (HMO-POS) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment benefits covered by Aetna Medicare Prime Value Plus (HMO-POS) require prior authorization and feature no copays. Durable medical equipment and diabetic supplies require 0% to 20% coinsurance, prosthetic devices require 20% coinsurance, and medical supplies and diabetic therapeutic shoes or inserts are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Prime Value Plus (HMO-POS) with no coinsurance. There is no copay for lab services, diagnostic tests, diagnostic radiology, and outpatient X-rays, though therapeutic radiological services require a $60 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Prime Value Plus (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime Value Plus (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond Medicare-covered stays are not covered. Covered stays require prior authorization and have no copay or coinsurance for days 1 through 20, and a $50 daily copay with no coinsurance for days 21 through 100.
Other Services See details
Aetna Medicare Prime Value Plus (HMO-POS) provides partial coverage for other services with no copay and no coinsurance for acupuncture, over-the-counter items, and select wellness exams. Meal benefits and dual eligible SNPs with highly integrated services are not covered under this plan.
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