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Aetna Medicare Elite (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 Elite (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Elite (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Connecticut. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Elite (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 Elite (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 Elite (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 $450.00 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 $6750.00 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 Elite (HMO-POS) plan has an enhanced alternative drug benefit. Before your coverage begins, you must first satisfy a $450 deductible. After your deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay when using a preferred pharmacy or mail order. Standard generic drugs have 22% coinsurance.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive coverage with varying cost-sharing. This plan covers inpatient hospital stays with a copay of $850, and outpatient services with copays ranging from $0 to $350. The plan includes coverage for primary care with no copay, as well as preventive services, hearing, vision, and dental services with no copay for many services. Additional benefits include home health services, and skilled nursing facility (SNF) services with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. For Inpatient Hospital-Acute, there is a copay of $850 per admission or stay, and additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a copay of $1937 per admission or stay; additional days and non-Medicare stays are not covered.
Outpatient Services See details
Outpatient services with the Aetna Medicare Elite (HMO-POS) plan include outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for many outpatient services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (HMO-POS) plan, but requires prior authorization. You will pay a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance; 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. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $285 copay.
Primary Care See details
Primary Care benefits with the Aetna Medicare Elite (HMO-POS) plan include primary care physician services with no copay, chiropractic services with a $15 copay for routine care, and occupational therapy services with a $40 copay. Other benefits include physician specialist services with a copay between $0 and $45, mental health specialty services, psychiatric services, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and also cover additional preventive services such as health education, wigs for hair loss due to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Elite (HMO-POS) plan, including hearing exams with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, with the plan covering one routine hearing exam and one fitting/evaluation per year. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0 to $45, while routine eye exams have no copay; eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $200 every year.
Dental Services See details
The Aetna Medicare Elite (HMO-POS) plan covers dental services, with a $1,000 annual maximum. Medicare dental services have a $45 copay, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have 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 under the Aetna Medicare Elite (HMO-POS) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment are covered by the Aetna Medicare Elite (HMO-POS) plan. DME has a coinsurance between 0% and 20%, and Prosthetic devices have a 20% coinsurance, while Medical Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $45, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $195, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (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 covered by the Aetna Medicare Elite (HMO-POS) plan, but the specific services like 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 are not covered. There may be a copay for the services that are covered, but the specific amount is not mentioned.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Elite (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $75 every three months, and includes Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, 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. The plan also covers a meal benefit with no copay, and other services including an annual wellness exam, screening mammography, gFOBT, and FIT, all with no copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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