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Aetna Medicare SmartFit (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare SmartFit (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 SmartFit (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare SmartFit (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Nebraska. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare SmartFit (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 SmartFit (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 SmartFit (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 $4000.00 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 SmartFit (HMO-POS) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies and mail order, or a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance, and preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency services have copays of $140, while urgent care has a $50 copay. The plan also covers primary care, specialist visits, and therapy services with copays between $0 and $40, as well as preventive services like annual exams and vision and hearing services with no copay. Additional benefits include dental services with no copay for most services, home health services with no copay, and coverage for medical equipment and home infusion services with varying coinsurance. The plan also covers ambulance services with a copay, and skilled nursing facility stays with copays depending on the length of stay. There is also an OTC benefit of $30 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay of $0-$400 for outpatient hospital services, and a $400 copay for observation services. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, Group Sessions for Outpatient Substance Abuse, and Outpatient Blood Services are also covered, with copays of $0, $40, $40, and $0, respectively.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare SmartFit (HMO-POS) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare SmartFit (HMO-POS) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $335 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Aetna Medicare SmartFit (HMO-POS), with a $140 copay for emergency services and a $50 copay for urgently needed services. Worldwide emergency services are also covered, with a $140 copay for worldwide emergency and urgent coverage, and a $335 copay for worldwide emergency transportation, up to a maximum of $150,000.
Primary Care See details
The Aetna Medicare SmartFit (HMO-POS) plan covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. The plan also covers physician specialist services, physical therapy, and speech-language pathology services with a $20 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions, and other health care professional services have copays between $0 and $20. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services like health education, nutritional/dietary benefits, wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, fitness benefit, and remote access technologies, all with no copay. 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 Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, but the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum of $310.00 per year for all eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other services like 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 with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit coverage of $1200 every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare SmartFit (HMO-POS) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare SmartFit (HMO-POS) plan, but prior authorization is required. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, though DME for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance and no copay, while diabetic equipment is covered, including diabetic supplies with 0% to 20% coinsurance, and diabetic therapeutic shoes/inserts with a 20% coinsurance, though prior authorization and specific manufacturers may be required.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, and Lab Services with no copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare SmartFit (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 SmartFit (HMO-POS) plan. However, intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartFit (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare SmartFit (HMO-POS) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $30 every three months. Other services such as acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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