Aetna Medicare Advantra Select (HMO-POS)

Utah Medicare Advantage Plan (2025 Plan)


Monthly Premium

Your Cost
$22
by Aetna Medicare

Additional Coverage

HearingVisionDental

Overall Government Star Rating

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Plan Name
Aetna Medicare Advantra Select (HMO-POS)
Insurance Carrier
Aetna Medicare
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Network Type
HMO

Aetna Medicare Advantra Select (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Utah and offered by the health insurance company Aetna Medicare. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.

Monthly Premium
$22
Annual Deductible
$0
Max Out-of-Pocket
$6,750
Primary doctor visit
$0 copay
Specialist visit
$0-50 copay per visit
ER visit
$125 copay per visit (always covered)
Ambulance
$350 copay

Aetna Medicare Advantra Select (HMO-POS) has a monthly premium cost of $22 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,750 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Aetna Medicare Advantra Select (HMO-POS) are defined below.

Yes
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing

Aetna Medicare Advantra Select (HMO-POS) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Aetna Medicare Advantra Select (HMO-POS) includes coverage for hearing, vision, dental.

Medicare Advantage health plans can offer even more additional benefits. Aetna Medicare Advantra Select (HMO-POS) includes coverage for the following additional benefits:

Other benefits

Fitness benefit
Limited coverage
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Not covered
Annual physical exams
Limited coverage
Telehealth
Limited coverage

Monthly Premium
$22
Health Portion of Premium
$0
Drug Portion of Premium
$22
Health Plan Deductible
$0
Health Plan Max Out-of-Pocket
$6,750 In-network
Nationwide Coverage included
No
Hearing Coverage included
Yes
Vision Coverage included
Yes
Dental Coverage included
Yes

Doctor Services

Primary doctor visit
In-network: $0 copay
Specialist visit
In-network: $0-50 copay per visit

Tests, labs, & imaging

Diagnostic tests & procedures
In-network: $0-5 copay
Lab services
In-network: $0 copay
Diagnostic radiology services (like MRI)
In-network: $0-295 copay
Outpatient x-rays
In-network: $0 copay
Emergency care
$125 copay per visit (always covered)
Urgent care
$50 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage
In-network: $395 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: Not Applicable
Outpatient hospital coverage
In-network: $0-400 copay per visit

Skilled nursing facility

Skilled nursing facility
In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: Not Applicable

Preventive services

Preventive services
In-network: $0 copay

Ambulance

Ground ambulance
In-network: $350 copay

Therapy services

Occupational therapy visit
In-network: $20 copay
Physical therapy & speech & language therapy visit
In-network: $20 copay

Mental health services

Outpatient group therapy with a psychiatrist
In-network: $40 copay
Outpatient individual therapy with a psychiatrist
In-network: $40 copay
Outpatient group therapy visit
In-network: $40 copay
Outpatient individual therapy visit
In-network: $40 copay

Opioid treatment services

Opioid treatment services
Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)
In-network: 0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Diabetes supplies
In-network: 0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseCatastrophic coverage phase
Preferred Generic$2.00 copay$0 copay
Generic$12.00 copay$0 copay
Preferred Brand24% coinsurance$0 copay
Non-Preferred Drug25% coinsurance$0 copay
Specialty Tier25% coinsurance$0 copay

Part B Drugs

Chemotherapy drugs
In-network: 0-20% coinsurance
Other Part B drugs
In-network: 0-20% coinsurance

Hearing

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Hearing aids - All types
In-network: $0 copay

Preventive Dental

Oral exam
In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 50% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services
In-network: $0 copay
Out-of-network: 50% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: 50% coinsurance
Prosthodontics, removable
In-network: $0 copay
Out-of-network: 50% coinsurance
Prosthodontics, fixed
In-network: $0 copay
Out-of-network: 50% coinsurance
Maxillofacial prosthetics
Not covered
Implant services
Not covered
Oral and maxillofacial surgery
In-network: $0 copay
Out-of-network: 50% coinsurance
Orthodontics
Not covered
Adjunctive general services
In-network: $0 copay
Out-of-network: 50% coinsurance

Vision

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Eyeglass frames (only)
In-network: $0 copay
Eyeglass lenses (only)
In-network: $0 copay
Upgrades
In-network: $0 copay

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