Both Aetna CVS Health HMO and Medicare Advantage plans provide comprehensive health coverage, but they cater to different populations and have distinct features. Aetna CVS Health HMO plans offer benefits like CVS pharmacy access and discounts, while Medicare Advantage plans include prescription drug coverage and emergency care. The choice depends on individual needs, preferences for network flexibility, and cost considerations. Medicare Advantage plans have customer satisfaction data available, which can aid in decision-making.
| Attribute | Aetna CVS Health HMO | Medicare Advantage (various plans) |
|---|---|---|
| Monthly Premium Cost | Not available | Average monthly premiums for Medicare Advantage plans in 2025 are projected to be around $17, but can range from $0 to $200 or more. Enrollees are also responsible for paying the Medicare Part B premium, which is $185 in 2025. |
| Deductible Amount | Varies by plan. Examples: Individual: $1,500 / Family: $3,000; Individual: $5,000 / Family: $10,000; Individual: $7,795 / Family: $15,590; Individual $6,500; Some plans have a $0 deductible. | Deductibles vary by plan. Medicare Part D, which often is included in Medicare Advantage, can have a deductible of no more than $590 in 2025. |
| Copay for Doctor Visits | Primary care: $0 to $40 (some plans offer $0 copays); Specialist visits: $10 to $80 | Copays are a fixed amount you pay for covered medical service. |
| Coverage for Prescription Drugs | Every ACA plan covers prescription drugs. Some plans offer $0 copays for Tier 1 drugs. Access to CVS retail pharmacies for certain specialty drugs. 20% discount on CVS Health brand products. | Most Medicare Advantage plans include prescription drug coverage (MA-PDs). Formularies (drug lists) vary, so it's important to check if your medications are covered. |
| In-Network Doctor Availability | Aetna has a large network. HMO plans typically limit coverage to in-network providers. Use Aetna's online provider search tool. | Access to in-network providers is a key factor for customer satisfaction. HMO plans generally only cover in-network providers. Use online tools to find in-network doctors. |
| Out-of-Pocket Maximum | Varies by plan. Examples: Individual: $8,700 / Family: $17,400; Individual: $8,000 / Family: $16,000; Individual: $8,845 / Family: $17,690; Individual: $2,000 / Family: $4,000. | In 2025, the maximum out-of-pocket limit for Medicare Advantage plans is $9,350 for approved services, but plans can set lower limits. |
| Coverage for Specialist Referrals | HMO plans typically require a referral to see a specialist. Aetna Health Network Only plan does not require referrals or a PCP. | Plan flexibility varies; some plans, like HMOs, may require referrals to see specialists. |
| Emergency Room Coverage | Generally covered. Some plans have a copay, sometimes waived if admitted. Out-of-network emergency care cost-share is sometimes the same as in-network. | Medicare Advantage plans cover emergency room visits. They must cover emergency care as in-network, even if the facility is out-of-network. |
| Preventive Care Coverage | ACA plans cover preventive services. Many Aetna CVS Health plans offer 100% coverage for preventive care. | Medicare Advantage plans cover preventive services. |
| Telehealth Services Offered | Yes. Some plans offer $0 virtual care through CVS Health Virtual Care. CVS Minute Clinics are a covered benefit. | Medicare Advantage plans may offer telehealth services, which have expanded in recent years. |
| Customer Satisfaction Ratings | Not available | Overall customer satisfaction for Medicare Advantage plans was 652 (on a 1,000-point scale) in a 2024 study. |
| Plan Flexibility (e.g., referrals required) | HMO plans generally require a primary care physician (PCP) and referrals to see specialists. EPO plans offer more flexibility. Aetna Health Network Only plan does not require referrals or a PCP. | HMO plans typically require you to stay within the network, while PPO plans offer more flexibility to see out-of-network providers, but at a higher cost. |