Skip to content
The Pocket Protector, home
Medicare Advantage · HMOPOS
Aetna Medicare
Plan year 2027

Aetna Medicare PinnacleHealth Prime (HMO-POS) H3959-093

Monthly premium
$0
+ your Part B premium
Max out-of-pocket
$7,150
in-network annual cap
Primary care
$0
per visit copay
Specialist
$20
per visit

Your costs at a glanceIn-network, for the 2027 plan year

Medical deductible
$0
Rx deductible
$400
Inpatient hospital
$400
per stay
no limit on covered hospital days
Inpatient mental health
Days 1-5: $350/day, Days 6-90: $0/day
Outpatient surgery
$250
Emergency room
$130
Urgent care
$50

What's included, and what it's actually worth5 benefits included. Tap any card for the detail

Hearing

$500/yr hearing aid allowance
Hearing aid allowance$500/yr hearing aid allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$250/yr eyewear allowance
Eyewear allowance$250/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

OTC allowance

$40/quarter OTC allowance
Prepaid card$40/quarter OTC allowance
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist$20 copay
In-network$20 copay per visit
Inpatient Hospital$400 per stay
In-network$400 per stay
Benefit limitNone — additional covered days are unlimited
Outpatient Surgery$250 copay
In-network$250 copay per procedure
Mental HealthDays 1-5: $350/day, Days 6-90: $0/day
Inpatient psychiatricDays 1-5: $350/day, Days 6-90: $0/day
Fitness$0 fitness benefit
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Our take

Where this plan shines

This plan has a $0 monthly premium.
See your primary doctor for $0.
The specialist copay ($20) is among the more affordable options.
No separate medical deductible.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Plan questions

Common questions about Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS)

What does Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) cover?

Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) is a Medicare Advantage plan that the current plan record identifies as including Part D prescription drug coverage. The plan record also identifies Part D prescription drug coverage. Published supplemental benefits include vision ($250/yr eyewear allowance), hearing ($500/yr hearing aid allowance), over-the-counter (OTC) ($40/quarter OTC allowance), and fitness ($0 fitness benefit). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) cost in 2027?

The published 2027 monthly plan premium for Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $400. The in-network medical out-of-pocket maximum is $7,150; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $20. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS)?

CMS lists Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) as a HMOPOS plan. The record also identifies point-of-service flexibility, but exact out-of-network rules can vary. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

Does Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) cover my prescriptions?

The current plan record for Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) does not include tier-level formulary costs. The listed Part D deductible is $400. A tier listing does not confirm that a specific prescription is covered. Check each medication against the plan's current formulary, restrictions, pharmacy network, and costs before enrolling.

Check your prescriptions

What dental, vision, and hearing benefits does Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) include?

The current plan record for Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) lists vision ($250/yr eyewear allowance) and hearing ($500/yr hearing aid allowance). It also lists over-the-counter (OTC) ($40/quarter OTC allowance). The current data does not list dental as offered benefits. Benefit allowances, frequency, eligibility, and participating providers can have additional limits, so review the Summary of Benefits or Evidence of Coverage for the complete rules.

When can I enroll in Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS)?

Aetna Medicare PinnacleHealth Prime (HMO-POS) (HMOPOS) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. A qualifying circumstance may create a Special Enrollment Period outside those dates. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

More plan options

Browse the full 2027 Medicare Advantage with drug coverage directory. This plan is offered in Pennsylvania. Plan availability can vary by county.

Helpful next steps