Aetna Medicare Enhanced (HMO-POS)
Aetna Medicare
HMO-POSSanta Clara CountyIncludes Part DPlan year 2026
$65/momonthly premium
$3,900most you pay in-network per year
3overall CMS star rating
—enrollment not published
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
In-network out-of-pocket maximum$3,900
Plan premium, per month$55
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient hospital stay
Days 1–7$400 per day
Days 8–90$0 per day
Inpatient psychiatric stay
Days 1–7$370 per day
Days 8–90$0 per day
Skilled nursing facility stay
Days 1–20$20 per day
Days 21–100$218 per day
Doctor visits
Primary care visit
$0
You pay nothing
Specialist visit
$0
You pay nothing
Telehealth visit
20%
Coinsurance — your share of the bill
Other health care professional
$0
You pay nothing
Chiropractic care (Medicare-covered)
$0
You pay nothing
Routine chiropractic care
$0
You pay nothing
Podiatry (Medicare-covered)
$0
You pay nothing
Emergency and urgent care
Emergency room visit
$150
Copay
Urgent care visit
$65
Copay
Emergency care outside the U.S.
$150
Copay
Up to $250,000
Urgent care outside the U.S.
$150
Copay
Emergency transportation outside the U.S.
$300
Copay
Mental health and substance use
Individual therapy session
$10
Copay
Group therapy session
$10
Copay
Opioid treatment program
$10
Copay
Partial hospitalization program
$0–$180
Copay, depends on the service
Prior authorization required
Therapy and rehabilitation
Occupational therapy
$0
You pay nothing
Physical and speech therapy
$0
You pay nothing
Cardiac rehabilitation
$0
You pay nothing
Intensive cardiac rehabilitation
$0
You pay nothing
Pulmonary rehabilitation
$0
You pay nothing
Supervised exercise therapy for peripheral artery disease
$0
You pay nothing
Tests, labs and imaging
Lab services
$0
You pay nothing
Diagnostic tests
$0
You pay nothing
Diagnostic procedures
$0
You pay nothing
Diagnostic radiology (MRI, CT, PET)
$0
You pay nothing
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$0–$475
Copay, depends on the service
Ambulatory surgical center
$0–$425
Copay, depends on the service
Observation services
$400
Copay
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
0%
You pay nothing
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
$35
Copay
Vision
Eye exam (Medicare-covered)
$0
You pay nothing
Routine eye exam
$0
You pay nothing
Other eye exams
$0
You pay nothing
Eyewear after cataract surgery (Medicare-covered)
$0
You pay nothing
Eyeglasses (lenses and frames)
$0
You pay nothing
Eyeglass lenses
$0
You pay nothing
Eyeglass frames
$0
You pay nothing
Contact lenses
$0
You pay nothing
Eyewear upgrades
$0
You pay nothing
Eyewear allowance
Up to $100 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
$0
You pay nothing
Routine hearing exam
$0
You pay nothing
Hearing aid fitting and evaluation
$0
You pay nothing
Prescription hearing aids
$0
You pay nothing
Up to $1,250 per year, per ear
Extra benefits
Acupuncture
$0
You pay nothing
Annual wellness exam and screening mammography
$0
You pay nothing
Additional gFOBT and FIT not covered by Medicare
$0
You pay nothing
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
No supplemental benefits are filed for this plan.
Not offered by this plan
Health EducationIn-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingFitness BenefitEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services
Prescription drugs (Part D)
$300 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $2 copay | No copay | — | Waived |
| 2. Generic | $10 copay | $12 copay | $10 copay | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $2 copay | No copay | — | Waived |
| 2. Generic | $10 copay | $12 copay | $10 copay | — | Waived |
| 3. Preferred Brand | 25% coinsurance | 25% coinsurance | 25% coinsurance | $35 | Applies |
| 4. Non-Preferred Drug | 26% coinsurance | 26% coinsurance | 26% coinsurance | $35 | Applies |
| 5. Specialty Tier specialty | 29% coinsurance | 29% coinsurance | 29% coinsurance | $35 | Applies |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | $35 | Applies |
| 4. Non-Preferred Drug | No copay | No copay | No copay | $35 | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | $35 | Applies |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
3 out of 5Overall rating
3 out of 5Health services (Part C)
3.5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
4- Annual flu vaccine3
- Breast cancer screening4
- Colorectal cancer screening4
- Monitoring physical activity3
- Improving or maintaining mental health3
- Improving or maintaining physical health4
Managing chronic (long-term) conditions
3- Readmissions4
- Kidney health4
- Blood pressure4
- Reducing falls4
- Statin therapy4
- Bladder control1
- Diabetes eye exam4
- Transitions of care2
- Diabetes blood sugar4
- Osteoporosis management4
- Followup after emergency department visit2
- Medication reconciliation4
Member experience with the health plan
1- Customer service1
- Care coordination2
- Healthcare quality2
- Health plan rating1
- Getting needed care1
Member complaints and changes in the plan's performance
3- Complaints3
- Members leaving3
- Quality improvement3
Health plan customer service
4- Call center4
- Timely decisions4
- Appeals decisions3
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
3- Complaints3
- Members leaving3
- Quality improvement2
Member experience with the drug plan
- Drug plan rating3
Drug safety and accuracy of drug pricing
4- Price accuracy5
- Statin diabetes4
- Medication therapy management comprehensive medication review completion5
- Medication adherence for diabetes medications3
- Medication adherence for hypertension RAS antagonists s4
- Medication adherence for cholesterol statins3
Why members leave this contract
Service area and network
Service area not published.
Doctor directory
2,154 providers are named in Aetna Medicare’s directory for this plan, dated Jun 26, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.