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Aetna Medicare Preferred Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred 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 Preferred Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred Plus (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 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Preferred 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 Preferred 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 Preferred Plus (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $399.00 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 Preferred Plus (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your costs may be reduced.
Additional Benefits
The Aetna Medicare Preferred Plus (HMO-POS) plan offers a range of benefits with varying cost-sharing. Many services, including inpatient hospital stays, outpatient services, primary care, preventive services, hearing exams, vision exams, dental services, and home health services, come with no copay. Other services, such as ambulance, emergency services, and home infusion, have copays or coinsurance. The plan also covers partial hospitalization, transportation services, and various diagnostic and radiological services, often with no copay. Additionally, there are allowances for hearing aids, eyewear, and dental services, with annual maximums for certain services. However, it's important to note that certain services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is no copay for a Medicare-covered stay. Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Preferred Plus (HMO-POS) plan, with a $0 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Preferred Plus (HMO-POS), with a $275 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay for 12 one-way trips per year, using rideshare services, bus/subway, or medical transport, while 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 by Aetna Medicare Preferred Plus (HMO-POS). Emergency Services has a $140 copay and no coinsurance, Urgently Needed Services has no copay and no coinsurance, and Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Aetna Medicare Preferred 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, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have no copay. Additional telehealth benefits have a 20% coinsurance and no copay. Occupational therapy services, mental health specialty services, other health care professional services, psychiatric services, and opioid treatment program services have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like health education, wigs for hair loss related to chemotherapy, and fitness benefits. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids (all types) are covered with no copay, up to a maximum of $1250 per year. OTC hearing aids, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum of $275 per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $1,250 annual maximum for other dental services.
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 have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Preferred Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Preferred Plus (HMO-POS) plan, with Durable Medical Equipment (DME) subject to 0-20% coinsurance and Prosthetic Devices subject to 20% coinsurance; Medical Supplies have no coinsurance, and Diabetic Supplies have 0-20% coinsurance. Durable Medical Equipment for use outside the home is not covered, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered by Aetna Medicare Preferred Plus (HMO-POS). There is no copay for diagnostic procedures/tests, lab services, and outpatient X-ray services. Therapeutic Radiological Services have a $60 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Preferred 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 Preferred Plus (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Preferred Plus (HMO-POS) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $50.
Other Services See details
Under the Aetna Medicare Preferred Plus (HMO-POS) plan, acupuncture and certain other services are covered. Acupuncture has no copay, and over-the-counter (OTC) items are covered with no copay up to $75 every three months. Meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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