2027 Medicare Advantage plan

Aetna Medicare Signature Extra (HMO-POS): 2027 benefits and costs

Aetna Medicare HMO-POS

CMS plan ID: H0628-003-0 · Plan year: 2027

Aetna Medicare Signature Extra (HMO-POS) is a 2027 Medicare Advantage plan offered by Aetna Medicare. It is listed in Ohio.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$500.00

In-network medical out-of-pocket maximum$4,900.00

Organization: Aetna Medicare
Plan organization: AETNA HEALTH OF OHIO INC.
Parent company: CVS Health Corporation
Plan type: HMO-POS
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $4,900.00
Applies to certain in-network supplemental services.
Combined in/out-of-network medical maximum: Not applicable
Out-of-network medical maximum: Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Telehealth	$0.00 to $50.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Emergency care	$130.00 copay
Urgent care	$50.00 copay
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$10.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered foot care	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Other health professionals	$0.00 to $40.00 copay Service-specific deductible No	Approval required No Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–6: $380.00 copay per day Days 7–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–6: $380.00 copay per day Days 7–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0.00 to $380.00 copay Service-specific deductible No
Hospital observation services	$380.00 copay Service-specific deductible No
Ambulatory surgical center	$0.00 to $245.00 copay Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$0.00 to $175.00 copay Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
X-rays	$0.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Mental health, individual sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	$25.00 copay Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$250.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0.00 copay Service-specific deductible No	Approval required Yes
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	Point-of-service
Medicare-covered dental	$40.00 copay	Not summarized. Check coverage with the plan.
Oral examsAdditional plan benefit	$0.00 copay	50% coinsurance Deductible applies No Dollar benefit limit applies No
Dental X-raysAdditional plan benefit	$0.00 copay	50% coinsurance Deductible applies No Dollar benefit limit applies No
Dental cleaningAdditional plan benefit	$0.00 copay	50% coinsurance Deductible applies No Dollar benefit limit applies No
Restorative dental careAdditional plan benefit	20% to 50% coinsurance	50% to 70% coinsurance Deductible applies No Dollar benefit limit applies No
Root canal treatment (endodontics)Additional plan benefit	20% coinsurance	50% coinsurance Deductible applies No Dollar benefit limit applies No
Gum treatment (periodontics)Additional plan benefit	20% to 50% coinsurance	50% to 70% coinsurance Deductible applies No Dollar benefit limit applies No
Removable dentures (prosthodontics)Additional plan benefit	50% coinsurance	70% coinsurance Deductible applies No Dollar benefit limit applies No
Fixed dental restorations (prosthodontics)Additional plan benefit	50% coinsurance	70% coinsurance Deductible applies No Dollar benefit limit applies No
Oral surgeryAdditional plan benefit	20% to 50% coinsurance	50% to 70% coinsurance Deductible applies No Dollar benefit limit applies No
Other dental servicesAdditional plan benefit	20% to 50% coinsurance	50% to 70% coinsurance Deductible applies No Dollar benefit limit applies No

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 to $40.00 copay Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0.00 copay	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$40.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0.00 copay Service-specific deductible No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Benefits for qualifying members

Cancer Care

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 1
Qualifying conditions: Cancer
To qualify: High value provider
Covered package services cost $0 until the package limit is reached: No
Benefits that apply to reduced cost sharing: Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing: Physician Specialist Services; Additional Telehealth Benefits
Does your MA Uniformity Flexibility/SSBCI cost reduction cover all or some Specialists under Physician Specialist Services?: Some specialists
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: Yes
Benefits that apply to being exempt from the plan-level deductible: Medicare-covered benefits
Medicare benefits that are exempt from the plan level deductible: Physician Specialist Services; Additional Telehealth Benefits
Do you offer reduced Coinsurance?: No
Service-specific deductible: No
Reduced Copayment?: Yes
Types of benefits that apply to the copayment cost sharing: Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment: Additional Telehealth Benefits
Minimum Copayment for Additional Telehealth Benefits: $0.00
Maximum Copayment for Additional Telehealth Benefits: $0.00
Specialists reduced coinsurance?: No
Specialists reduced copayment?: Yes
Specialists with the reduced copayment: Oncology - Radiation/Radiation Oncology; Oncology - Medical, Surgical
Minimum Copayment Amount for Oncology - Medical, Surgical: $0.00
Maximum Copayment Amount for Oncology - Medical, Surgical: $0.00
Minimum Copayment Amount for Oncology - Radiation/Radiation Oncology: $0.00
Maximum Copayment Amount for Oncology - Radiation/Radiation Oncology: $0.00

Full package terms are not summarized here.

Recovery at Home Program

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Other 5; Congestive Heart Failure (CHF); Other 1; Other 2; Other 3; Other 4
Qualifying conditions: Fractures
Qualifying conditions: Neurologic Disorders
Qualifying conditions: Musculoskeletal (MSK)
Qualifying conditions: Pneumonia
Qualifying conditions: Urologic Conditions
All listed conditions required: No
Combination of conditions required: No
To qualify: Participation in a Care Management Program
Included services: In-Home Support Services
Applies to out-of-network or point-of-service care: No
Some package benefits are exempt from the deductible: Yes
Services exempt from the deductible: In-Home Support Services

Full package terms are not summarized here.

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$5.00	$10.00	$15.00
Tier 3Preferred Brand	17%	17%	17%
Tier 4Non-Preferred Drug	28%	28%	28%
Tier 5Specialty Tier	28%	Not listed	Not listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$5.00	$10.00	$15.00
Tier 2Generic	$12.00	$24.00	$36.00
Tier 3Preferred Brand	17%	17%	17%
Tier 4Non-Preferred Drug	28%	28%	28%
Tier 5Specialty Tier	28%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, but the number of days you can fill is limited. Check the supply lengths below and the plan’s out-of-network rules.

Preferred mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$5.00	$5.00	$5.00
Tier 3Preferred Brand	17%	17%	17%
Tier 4Non-Preferred Drug	28%	28%	28%
Tier 5Specialty Tier	28%	Not listed	Not listed

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$5.00	$10.00	$15.00
Tier 2Generic	$12.00	$24.00	$36.00
Tier 3Preferred Brand	17%	17%	17%
Tier 4Non-Preferred Drug	28%	28%	28%
Tier 5Specialty Tier	28%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$12.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	28%
Tier 5Specialty Tier	28%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	10 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$12.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	28%
Tier 5Specialty Tier	28%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.