A non-government entity
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 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 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:
Sign up for Aetna Medicare Prime Extra (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Prime Extra (HMO-POS) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generic drugs have no copay at preferred pharmacies and preferred mail-order services, or a $12.00 copay at standard pharmacies. For other tiers, you will pay a 24% coinsurance for Tier 2 standard generics, and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase. During this phase, you pay nothing for Medicare Part D covered drugs. Additionally, if you qualify for the low-income subsidy, your cost-sharing is reduced to no cost.
Additional Benefits
The Aetna Medicare Prime Extra (HMO-POS) plan offers comprehensive medical coverage featuring no copays and no coinsurance for inpatient hospital stays, outpatient services, and primary care visits. While routine doctor visits and home health care cost nothing out-of-pocket, emergency room visits require a $150 copay, and ground ambulance services carry a $275 copay. Diagnostic services like labs and X-rays also feature no copays, though specialized diagnostic imaging may require copays up to $60. This plan provides strong supplemental benefits, including no copays or coinsurance for routine vision and hearing exams, along with annual allowances for eyewear and prescription hearing aids. Dental care is covered with no copay for preventive services, while comprehensive dental treatments require a coinsurance between 20% and 50% up to a $1,500 annual limit. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and members receive a $45 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Prime Extra (HMO-POS) with no copay or coinsurance for Medicare-covered acute and psychiatric stays, though prior authorization is required. Upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Aetna Medicare Prime Extra (HMO-POS) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copays and no coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under Aetna Medicare Prime Extra (HMO-POS) with a copay ranging from no copay to $180 and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Prime Extra (HMO-POS), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Aetna Medicare Prime Extra (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 feature no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $150 to $275.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Prime Extra (HMO-POS), as podiatry services are not covered. Most covered services, including primary care visits, chiropractic care, and therapy, feature no copay and no coinsurance, while telehealth benefits require a 20% coinsurance and no copay.
Preventive Services See details
Aetna Medicare Prime Extra (HMO-POS) partially covers preventive services, offering annual physicals, health education, and screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Prime Extra (HMO-POS), providing routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Prime Extra (HMO-POS) with no copay and no coinsurance, including one routine eye exam per year and unlimited follow-up diabetic eye exams. Covered eyewear, such as contacts, eyeglasses, and upgrades, also features no copay or coinsurance up to a combined maximum benefit of $225 every year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime Extra (HMO-POS), with no copay and no coinsurance for Medicare dental services, oral exams, cleanings, and dental X-rays. Comprehensive services, including restorative care, endodontics, periodontics, prosthodontics, and oral surgery, are covered with no copay and a 20% to 50% coinsurance up to a $1,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Prime Extra (HMO-POS) covers home infusion bundled services, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Prime Extra (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Prime Extra (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with prior authorization required. Beneficiaries will pay no copay for these services, with coinsurance ranging from 0% to 20% for durable medical equipment and diabetic supplies, 20% coinsurance for prosthetic devices, and no coinsurance for medical supplies and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Prime Extra (HMO-POS) with no coinsurance. Members pay no copay for lab services, outpatient X-rays, and diagnostic tests, while diagnostic radiological services range from a $0 to $60 copay and therapeutic radiological services require a $60 copay.
Home Health Services See details
Home health services are covered under the Aetna Medicare Prime Extra (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Prime Extra (HMO-POS) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD). Because these services are not covered by the plan, there are no copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime Extra (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with prior authorization, featuring no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, with no coinsurance. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Prime Extra (HMO-POS) partially covers other services, offering no copay and no coinsurance for acupuncture, annual wellness exams, screening mammographies, additional colorectal screenings, and over-the-counter items with a $45 quarterly reimbursement limit. Meal benefits and Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved