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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 Kern 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 a $590.00 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 $2000.00 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 $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and where you get your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance, depending on the drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase.
Additional Benefits
The Aetna Medicare Preferred Plus (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have a copay of $250 for the first five days, and then no copay for the remainder, while outpatient services may have copays between $0 and $150. This plan provides coverage for primary care, preventive, hearing, vision, and dental services, often with no copay. Additionally, services like ambulance, emergency, and home health are covered, though some services may have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $250 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, there is a $250 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $150, observation services with a $250 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $10 copay, and outpatient blood services have no copay.
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, including ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are limited to 12 one-way trips per year with no copay, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including urgently needed services, are covered by the Aetna Medicare Preferred Plus (HMO-POS) plan. Emergency Services have a $140 copay, while urgently needed services have no copay. Worldwide Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, have a $140 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
Under the Aetna Medicare Preferred Plus (HMO-POS) plan, 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 are covered. Routine chiropractic care, primary care physician services, physician specialist services, and other health care professional services have no copay, while individual and group sessions for mental health and psychiatric services have a $10 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education and wigs for hair loss related to chemotherapy, both with no copay, are covered. Other preventive services, such as in-home safety assessments, are not covered. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have no copay, and are limited to a maximum of $1250.00 per year.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
The Aetna Medicare Preferred Plus (HMO-POS) plan covers various dental services, including 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. The plan also covers orthodontic services covered under Diagnostic and Preventive Dental (16b), with a maximum benefit of $1000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Preferred Plus (HMO-POS) plan. Durable Medical Equipment (DME) has no copay and 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 and no copay. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests and Lab Services with no copay, and Diagnostic Radiological Services and Therapeutic Radiological Services with a copay up to $60.00, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required for all diagnostic services.
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 a $0 copay for days 1-20 and a $100 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Preferred Plus (HMO-POS) plan covers acupuncture with no copay, and also covers over-the-counter (OTC) items with no copay up to $75 every three months, but does not cover meal benefits. Some other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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