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 Kern, 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 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.
Below are a few key facts and commonly-asked questions about Aetna Medicare Prime Value Plus (HMO-POS).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Aetna Medicare Prime Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.50. 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 $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.
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The Aetna Medicare Prime Value Plus (HMO-POS) plan has a $450 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies or through mail order. For standard generic drugs, you will pay 22% coinsurance.
The Aetna Medicare Prime Value Plus (HMO-POS) plan offers comprehensive coverage with a focus on keeping costs down. Many services, including inpatient hospital stays, outpatient services, primary care, preventive services, and home health services, come with no copay. The plan also provides benefits for hearing, vision, and dental services, with no copays for eye exams, eyewear, oral exams, dental x-rays, and other diagnostic dental services. However, some services have associated costs, such as ambulance services, emergency services, and some prescription drugs, and some services require coinsurance.
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with no copay for Medicare-covered stays. 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 are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services have no copay, and outpatient substance abuse services has no copay for individual and group sessions.
Partial Hospitalization is covered under the Aetna Medicare Prime Value Plus (HMO-POS) plan. There is no copay for this benefit.
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, up to 12 one-way trips per year, utilizing rideshare services, bus/subway, or medical transport.
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Prime Value 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; all have no coinsurance.
The Aetna Medicare Prime Value 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. There is no copay for primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, individual and group mental health and psychiatric sessions, and other health care professional services, while additional telehealth benefits have a 20% coinsurance. Podiatry services are not covered.
Preventive services include an annual physical exam with no copay, while additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, each with no copay. This plan also covers Kidney Disease Education Services with 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum benefit of $1250 per year. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum of $350 per year.
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; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan also offers a maximum of $2,000 per year for other dental services.
Home Infusion bundled Services are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services are covered under the Aetna Medicare Prime Value Plus (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance for these services.
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers medical equipment including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, 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 coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, and 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 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 are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral is required, and there is a copay, but the specific amount is not provided.
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan, but require prior authorization. You will have 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 for SNF are not covered.
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers acupuncture with no copay, and over-the-counter items with no copay up to $120 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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