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Aetna Medicare Prime Extra (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Extra (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 Extra (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Extra (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 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Prime Extra (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 Extra (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 Extra (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 $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 $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 Extra (HMO-POS) plan features an annual prescription drug deductible of $615.00. During the initial coverage phase, there is no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order, though standard pharmacies charge a $12.00 copay. For Tier 2 standard generic drugs, you will pay a 24% coinsurance regardless of the pharmacy or mail service you select. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both require a 25% coinsurance across all pharmacy and mail options. 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. If you qualify for the low-income subsidy, your Part D cost-sharing is also reduced to nothing.
Additional Benefits
The Aetna Medicare Prime Extra (HMO-POS) plan offers comprehensive coverage with no copays or coinsurance for many essential services, including Medicare-covered inpatient hospital stays, outpatient care, primary and specialist visits, and diagnostic lab tests. Routine dental, vision, and hearing exams are also covered with no copays, along with a $200 annual eyewear allowance. However, some urgent or specialized services require cost-sharing, such as a $150 copay for emergency room visits and a $275 copay for ground ambulance transportation. For specialized medical needs, the plan features a 20% coinsurance for dialysis, prosthetic devices, and durable medical equipment. Comprehensive dental services are covered with a 20% to 50% coinsurance up to a $2,000 annual limit, while skilled nursing facility stays require a $50 daily copay only for days 21 through 100. Note that certain services, such as routine transportation and cardiac rehabilitation, are not covered under this plan.
Inpatient Hospital See details
Aetna Medicare Prime Extra (HMO-POS) partially covers inpatient hospital benefits, offering Medicare-covered acute and psychiatric stays with no copay and no coinsurance. However, non-Medicare-covered stays, hospital upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Aetna Medicare Prime Extra (HMO-POS) covers outpatient services, including outpatient hospital care, ambulatory surgical center services, outpatient substance abuse sessions, and blood services, with no copay and no coinsurance. Prior authorization is required for most of these services, and there is no deductible.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Prime Extra (HMO-POS) with copays ranging from no copay to $180, and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Prime Extra (HMO-POS) partially covers Ambulance and Transportation Services, as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Prime Extra (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours, while urgently needed services have no copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $250,000 maximum limit with no coinsurance, requiring a $150 copay for medical services and a $275 copay for emergency transportation.
Primary Care See details
Primary Care benefits are partially covered under Aetna Medicare Prime Extra (HMO-POS), featuring no copay and no coinsurance for primary care, specialist, chiropractic, therapy, and mental health services, though podiatry services are not covered. Additional telehealth benefits are also covered with no copay and a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Prime Extra (HMO-POS), offering most services like annual physicals 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 weight management, therapeutic massage, personal emergency response systems, and in-home safety assessments.
Hearing Services See details
Aetna Medicare Prime Extra (HMO-POS) partially covers hearing services, offering routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear every year with no copay or coinsurance, but OTC hearing aids as well as inner, outer, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Prime Extra (HMO-POS) covers vision services with no copay or coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. Eyewear, including contact lenses, frames, lenses, and upgrades, is also covered with no copay or coinsurance up to a combined maximum benefit of $200 every year.
Dental Services See details
Aetna Medicare Prime Extra (HMO-POS) partially covers dental services, providing Medicare dental and preventive care like exams, cleanings, and x-rays with no copay. Comprehensive services are covered with a 20% to 50% coinsurance up to a $2,000 annual limit, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Aetna Medicare Prime Extra (HMO-POS) with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation, have no copay and require a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Prime Extra (HMO-POS) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Prime Extra (HMO-POS) covers medical equipment, with durable medical equipment and diabetic supplies requiring a 0% to 20% coinsurance and no copay. Prosthetic devices carry a 20% coinsurance with no copay, while medical supplies and diabetic therapeutic shoes or inserts are covered with no copay or coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Prime Extra (HMO-POS) covers diagnostic procedures, lab services, diagnostic radiology, and outpatient X-rays with no copay and no coinsurance. Therapeutic radiological services are covered with a $60 copay and no coinsurance, and prior authorization is required for these services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Prime Extra (HMO-POS) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Prime Extra (HMO-POS) does not cover Cardiac Rehabilitation Services, as none of the individual sub-services are covered in practice. There is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime Extra (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no copay for days 1 to 20, a $50 daily copay for days 21 to 100, and no coinsurance. Prior authorization is required, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Prime Extra (HMO-POS), providing acupuncture, annual wellness exams, and a $45 quarterly over-the-counter allowance with no copay and no coinsurance. Please note that meal benefits and highly integrated services for Dual Eligible SNPs are not covered.
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