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Aetna Medicare Plus II (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Plus II (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 Plus II (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Plus II (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Plus II (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 Plus II (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 Plus II (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 $799.00 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 Plus II (HMO-POS)
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Drug Coverage
The Aetna Medicare Plus II (HMO-POS) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay when using a preferred pharmacy or mail order, while standard generic drugs have 24% coinsurance. Preferred brand and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Plus II (HMO-POS) plan offers a wide range of benefits with varying costs. The plan covers inpatient hospital stays with a $250 copay for the first five days, and no copay thereafter, as well as outpatient services with copays ranging from $0 to $150. Additionally, the plan includes coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental services, often with no copay. The plan provides coverage for home infusion, dialysis, medical equipment, diagnostic services, and home health services, with costs varying based on the service. Some services like Skilled Nursing Facility (SNF) have copays, and some services, like cardiac rehabilitation, are not covered. It also includes coverage for other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits 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. Additional Days for Inpatient Hospital-Acute are covered with no copay, 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 not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $150, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay, and outpatient blood services with no copay. Prior authorization is required for several services.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization and no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Plus II (HMO-POS), including ground and air ambulance services, with a $245 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, up to 12 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Plus II (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, Worldwide Emergency Transportation has a $245 copay, and Urgently Needed Services has no copay.
Primary Care See details
The Aetna Medicare Plus II (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, other health care professional services, psychiatric services, and opioid treatment program services may have a copay. Mental health specialty services may have a copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education, wigs for hair loss related to chemotherapy, additional smoking cessation counseling, fitness benefits, and remote access technologies. Kidney disease education services have a 20% coinsurance. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $1250.00 per year, and inner ear, outer ear, and over the ear hearing aids are not covered, while OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Plus II (HMO-POS) covers vision services, including eye exams and eyewear. There is no copay for eye exams, routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $250 per year.
Dental Services See details
Dental services include 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, all with no copay. Orthodontic services have a maximum plan benefit of $1,000 per year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Plus II (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Plus II (HMO-POS), with Durable Medical Equipment (DME) covered with a coinsurance between 0% and 20%, and no copay. Prosthetic Devices have a 20% coinsurance, while 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, including Diagnostic Procedures/Tests and Lab Services, are covered with no copay. Therapeutic Radiological Services have a copay of up to $60.00, while Diagnostic Radiological Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Plus II (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 Plus II (HMO-POS) plan. No copay or coinsurance information is available for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Plus II (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Aetna Medicare Plus II (HMO-POS) covers acupuncture with no copay and over-the-counter items with no copay, up to $75 every three months. Other services like meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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