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Aetna Medicare Enhanced Extra (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced 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 Enhanced Extra (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Extra (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Santa Clara County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced 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 Enhanced 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 Enhanced Extra (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $71.00. 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 $3900.00 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 Enhanced Extra (HMO-POS) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. Beneficiaries who qualify for the low-income subsidy can receive a premium reduction, paying $18.80 instead of the standard $30.80 Part D premium. After meeting the deductible, you will pay copayments or coinsurance for your medications during the initial coverage phase. Under this phase, Tier 1 preferred generic drugs have no copay at preferred pharmacies and preferred mail-order services, or a $12.00 copay at standard pharmacies. Tier 2 standard generic drugs require 24% coinsurance, while Tier 3 preferred brand and Tier 4 non-preferred drugs require 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions.
Additional Benefits
The Aetna Medicare Enhanced Extra (HMO-POS) plan offers comprehensive coverage for essential medical services, often with low or no out-of-pocket costs. You will pay no copay and no coinsurance for primary care, specialist, and physical therapy visits, while emergency room visits carry a $150 copay that is waived if you are admitted. Inpatient hospital stays require daily copays for the first seven days with no coinsurance, whereas outpatient diagnostic procedures, lab work, and home health services are available with no copay and no coinsurance. For supplemental care, this plan features no copay and no coinsurance for routine dental cleanings, annual eye exams, and yearly hearing evaluations. Prescription hearing aids are covered up to a $1,250 annual maximum per ear with no copay, and comprehensive dental services require a 20% to 50% coinsurance up to a $500 yearly limit. Durable medical equipment and diabetic supplies are also covered, carrying a 0% to 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), featuring no coinsurance and daily copays of $400 for days 1 to 7 of acute care and $370 for days 1 to 7 of psychiatric care, with no copay for days 8 to 90. Non-Medicare-covered stays, upgrades for acute care, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Copays for other covered services range from $0 to $475 for outpatient hospital visits, $400 per stay for observation services, and $10 per session for outpatient substance abuse.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (HMO-POS) covers partial hospitalization benefits with prior authorization, requiring either no copay or a $180 copay, and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under the Aetna Medicare Enhanced Extra (HMO-POS) plan, as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $300 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Aetna Medicare Enhanced 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 require a $65 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with copays ranging from $150 to $300 and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), as podiatry services are not covered. Most included services, such as primary care, specialist, and physical therapy visits, feature no copay and no coinsurance, while mental health and psychiatric services require a $10 copay and no coinsurance, and telehealth services carry a $0 to $65 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Enhanced Extra (HMO-POS) partially covers preventive services, offering annual physicals, health education, and select screenings with no copay and no coinsurance, and kidney disease education with a 20% coinsurance and no copay. However, several supplemental services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), which offers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. While some prescription hearing aids are covered with no copay up to a $1,250 maximum per ear annually, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers vision services, including eye exams and eyewear, with no copay or coinsurance. This benefit includes one routine eye exam per year and a combined maximum allowance of $100 annually for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), featuring no copays or coinsurance for Medicare dental services, oral exams, x-rays, and cleanings. Comprehensive services require no copays and a 20% to 50% coinsurance up to a $500 yearly maximum, though fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), requiring prior authorization and excluding Part D home infusion drugs as a bundled service. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced Extra (HMO-POS), with prior authorization required for most items. Durable medical equipment and diabetic supplies carry a 0% to 20% coinsurance and no copay, prosthetic devices require a 20% coinsurance and no copay, while medical supplies and diabetic therapeutic shoes or inserts feature no copay and no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (HMO-POS) covers diagnostic procedures, lab services, diagnostic radiological services, and outpatient X-rays with no copay and no coinsurance. Therapeutic radiological services are covered with a 20% coinsurance, and prior authorization or doctor referrals are required for some of these services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Enhanced Extra (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Enhanced Extra (HMO-POS) plan, as none of the sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Enhanced Extra (HMO-POS), as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and carry a daily copay of $20 for days 1 to 20 and $218 for days 21 to 100, with no coinsurance.
Other Services See details
Aetna Medicare Enhanced Extra (HMO-POS) partially covers other services, offering acupuncture, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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