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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $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 annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, Tier 1 drugs have a $2 copay and Tier 2 drugs have a $12 copay for a one-month supply. For brand-name and specialty medications, the plan uses coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These cost-sharing percentages remain consistent whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits and low copays ranging from $0 to $50 for specialists. For hospital stays, members pay a daily copay of $415 for the first six days of acute inpatient care and no copay for days 7 through 90, while emergency services carry a $130 copay that is waived upon admission. Outpatient services and home health care are highly accessible with no coinsurance and no copay for many services. This plan also includes valuable supplemental benefits, such as preventive dental care and routine vision exams with no copays, alongside a $1,000 annual dental limit and a $125 eyewear allowance. Routine hearing exams are also covered with no copay, and prescription hearing aids are available with copays starting at $0. Additionally, members can take advantage of covered preventive benefits like fitness programs and annual physicals at no cost.
Inpatient Hospital See details
Aetna Medicare Elite (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $415 for days 1 through 6 of acute stays and $390 for days 1 through 6 of psychiatric stays, followed by no copay for days 7 through 90. Unlimited additional acute days are covered with no copay, but non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $400 copay and observation services with a $350 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $50 copay.
Partial Hospitalization See details
Aetna Medicare Elite (HMO-POS) covers partial hospitalization services with a copayment of either $70.00 or $145.00 and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Elite (HMO-POS) with a $285 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Prior authorization is required for ambulance services, and routine transportation services are not covered.
Emergency Services See details
Aetna Medicare Elite (HMO-POS) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $130 to $285.
Primary Care See details
Aetna Medicare Elite (HMO-POS) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies require a $50 copay and no coinsurance, while podiatry is not covered and chiropractic services are partially covered, excluding routine and other chiropractic care.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (HMO-POS), offering no copay and no coinsurance for annual physical exams, fitness benefits, and health education, while kidney disease education requires no copay and a 20% coinsurance. Several supplemental benefits are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, and in-home support services.
Hearing Services See details
Aetna Medicare Elite (HMO-POS) covers hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, alongside one annual routine exam and fitting evaluation with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700 for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Aetna Medicare Elite (HMO-POS) vision services are covered with no deductible and no coinsurance, featuring eye exam copays ranging from $0 to $50 and no copay for eyewear. This benefit includes one routine eye exam per year and a combined maximum allowance of $125 annually toward contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Elite (HMO-POS), offering a $1,000 annual maximum with no copay and no coinsurance for preventive care and most comprehensive services, while Medicare-covered dental requires a $50 copay and no coinsurance. Implant services, orthodontics, and maxillofacial prosthetics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Elite (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 25%. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (HMO-POS) with prior authorization required. Outpatient diagnostic procedures and tests have no coinsurance and a copay of $0 to $45, lab services have no copay or coinsurance, and radiological services range from a $0 minimum copay for diagnostic imaging to a 20% minimum coinsurance for therapeutic radiology and a $30 copay for X-rays.
Home Health Services See details
Aetna Medicare Elite (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Elite (HMO-POS) with no coinsurance, but only some services are covered. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (HMO-POS) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Aetna Medicare Elite (HMO-POS) partially covers other services, offering a chronic illness meal benefit, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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