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Aetna Medicare Prime II Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime II 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 II Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime II Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Orange 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 II 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 II 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 II Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.80. 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 II Value Plus (HMO-POS) plan has a $450 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, while standard pharmacies and standard mail order have a $12 copay. For other tiers, you will pay coinsurance between 22% and 27%. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Prime II Value Plus (HMO-POS) plan offers a wide range of benefits with many services available at no copay, including inpatient and outpatient services, primary care, preventive services, vision, hearing, dental, home health, and medical equipment. The plan also provides coverage for ambulance, emergency services, and skilled nursing facilities, with varying copays or coinsurance depending on the service. Overall, this plan offers comprehensive coverage with a focus on minimizing out-of-pocket costs for many common healthcare needs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay. Outpatient substance abuse services also have no copay.
Partial Hospitalization See details
Aetna Medicare Prime II Value Plus (HMO-POS) covers partial hospitalization with no copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Prime II Value Plus (HMO-POS) plan. 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 for up to 12 one-way trips per year with no copay, but 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 under the Aetna Medicare Prime II Value Plus (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $275 copay, and Urgently Needed Services has no copay.
Primary Care See details
For the Aetna Medicare Prime II Value Plus (HMO-POS) plan, primary care services, chiropractic services, occupational therapy, 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 are covered with no copay, while additional telehealth benefits have a 20% coinsurance and no copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Wigs for Hair Loss Related to Chemotherapy, and Fitness Benefits, with no copay. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, also with no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $1,250 per ear per year, with 2 visits per year and no copay. OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams and other eye exam services like follow up diabetic eye exams. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum plan benefit coverage amount of $350 per year.
Dental Services See details
Dental services are covered with a $2,000 maximum per year. There is no copay 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Prime II Value Plus (HMO-POS) plan and require prior authorization. You will pay a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Prime II Value Plus (HMO-POS) plan, with no copay for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Therapeutic Shoes/Inserts. The plan has a 0-20% coinsurance for DME, 20% coinsurance for Prosthetic Devices, and a 0-20% coinsurance for Diabetic Supplies. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, lab services, and all radiological services, but prior authorization and a doctor referral are required. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have no copay, Therapeutic Radiological Services have a copay of up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime II 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 not covered by the Aetna Medicare Prime II Value Plus (HMO-POS) plan. Although the plan mentions that it covers Cardiac Rehabilitation Services, it specifies that Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Prime II Value Plus (HMO-POS) plan, 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 and non-Medicare-covered stays are not covered.
Other Services See details
Under "Other Services," acupuncture and over-the-counter items are covered. Acupuncture has no copay, and over-the-counter items have no copay and a maximum benefit coverage amount of $120 every three months. Other services like meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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