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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 Southern New Hampshire. 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 $500.00 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 drug deductible of $500. For Tier 1 preferred generics and Tier 2 generics, members pay 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 copay of $2 to $6, and Tier 2 drugs have a copay of $12 to $36, depending on the supply. For higher-tier medications, the plan charges coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs have a 27% coinsurance for a one-month supply at both preferred and standard pharmacies or mail-order services.
Additional Benefits
The Aetna Medicare Elite (HMO-POS) plan offers comprehensive medical coverage, featuring no copay and no coinsurance for primary care doctor visits, home health services, and routine preventive care. Specialist visits, physical therapy, and urgent care require a copay of up to $45, while emergency room visits carry a $130 copay that is waived upon hospital admission. For hospital stays, inpatient acute care requires a $458 daily copay for the first six days with no copay thereafter, while outpatient hospital services range from no copay up to a $350 copay. Routine dental cleanings, annual eye exams, and routine hearing tests are fully covered with no copay and no coinsurance. The plan also provides up to $175 annually for covered eyewear with no copay, and covers up to two prescription hearing aids per year with copays ranging from no copay to $1,700. Most durable medical equipment is covered with no copay, though coinsurance ranges up to 25% depending on the items needed.
Inpatient Hospital See details
Aetna Medicare Elite (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $458 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $385 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $345 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copays and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Elite (HMO-POS) covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Elite (HMO-POS) plan are covered with a $315 copay for ground transport and 20% coinsurance for air transport, with prior authorization required. Transportation services to health-related locations are not covered by the plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite (HMO-POS) 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 $45 copay and no coinsurance, while worldwide emergency care and transportation are covered with no coinsurance and copays ranging from $130 to $315 up to a $250,000 maximum.
Primary Care See details
Aetna Medicare Elite (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services feature copays up to $45 and no coinsurance. Telehealth benefits are covered with a $0 to $45 copay and 20% coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Elite (HMO-POS), with most services like annual physicals, fitness benefits, and health education requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services such as personal emergency response systems, weight management, alternative therapies, therapeutic massage, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing Services are partially covered under Aetna Medicare Elite (HMO-POS), offering Medicare-covered exams for a $45 copay and no coinsurance, plus one annual routine exam and fitting evaluation with no copay and no coinsurance. Prescription hearing aids are covered for up to two devices per year with no coinsurance and copays ranging from $0 to $1,700, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite (HMO-POS) covers vision services with no coinsurance, offering annual routine eye exams and follow-up diabetic exams with no copay, while Medicare-covered eye exams have a copay of $0 to $45. Covered eyewear, including contacts, lenses, frames, and upgrades, has no copay and no coinsurance up to a combined maximum plan benefit of $175 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (HMO-POS), offering Medicare-covered dental for a $45 copay and no coinsurance, plus routine exams, cleanings, and x-rays with no copay and no coinsurance. Non-covered services include fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
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 insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% 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 with no copay, though prior authorization is required for most items. Durable medical equipment and medical supplies carry no coinsurance to 25% coinsurance, prosthetic devices require 25% coinsurance, and diabetic supplies have no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (HMO-POS) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab tests, and up to a $45 copay for procedures. Radiological services require a $30 copay and coinsurance for X-rays, a minimum 20% coinsurance and copays for therapeutic services, and no minimum copay and no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Elite (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Some Cardiac Rehabilitation Services are covered under Aetna Medicare Elite (HMO-POS) with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Elite (HMO-POS) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under Aetna Medicare Elite (HMO-POS) are partially covered with no copay and no coinsurance for chronic illness meals, annual wellness exams, and a quarterly $25 over-the-counter item allowance. Acupuncture is not covered under this benefit.
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