Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H0628-017

Medicare Plan

Aetna Medicare Signature Care (HMO-POS) · Aetna Medicare · HMOPOS · Greater Central Ohio Area

Full CMS plan ID: H0628-017-000

H0628-017-000 is the full CMS identifier for the H0628-017 Medicare plan. Common searches include H0628 017 and H0628017.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

Aetna Medicare Signature Care (HMO-POS)

H0628-017-000 Greater Central Ohio Area HMOPOS

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–7 $330 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $2,310
02

Emergency transport

Ambulance

Ground · in-network$260 copay
Air · in-network20% coinsurance

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$5,500
Combined in + outNot reported
05

Skilled care at home

Home health

In-network$0 copay
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$0 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Specialist

Verify in plan documents
In-network$40 copay
Out-of-networkNot separately reported

Preventive care

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

Verify in plan documents
In-network$0–$100 copay
Out-of-networkNot separately reported

Laboratory services

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

X-rays & standard imaging

Verify in plan documents
In-network$0–$225 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$130 copay
Out-of-networkNot separately reported

Ground ambulance

Verify in plan documents
In-network$260 copay
Out-of-networkNot separately reported

Air ambulance

Verify in plan documents
In-network20% coinsurance
Out-of-networkNot separately reported

Outpatient hospital

Verify in plan documents
In-network$0–$330 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

Verify in plan documents
In-network$0–$300 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

Verify in plan documents
In-network$20 copay
Out-of-networkNot separately reported

Occupational therapy

Verify in plan documents
In-network$40 copay
Out-of-networkNot separately reported

Physical & speech therapy

Verify in plan documents
In-network$40 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

Verify in plan documents
In-network$55 copay
Out-of-networkNot separately reported

Substance use treatment

Verify in plan documents
In-network$145 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

Verify in plan documents
In-network$40 copay
Out-of-networkNot separately reported

Chiropractic

Verify in plan documents
In-network$15 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

Verify in plan documents
In-network$40 copay
Out-of-networkNot separately reported

Vision

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Hearing

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$5,500
Combined in + outNot reported

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMOPOS · Referrals: Not required · Out-of-network coverage: Not reported

Prescription drugs5 tiers

Part D deductible

Not reported

Drug tier 1

$2 retail copay · 30-day supply

Drug tier 2

$12 retail copay · 30-day supply

Drug tier 3

22% retail coinsurance · 30-day supply

Drug tier 4

25% retail coinsurance · 30-day supply

Drug tier 5

27% retail coinsurance · 30-day supply

Using this plan

Understand H0628-017-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

Aetna Medicare Signature Care (HMO-POS) is a 2026 HMOPOS offered by Aetna Medicare in Greater Central Ohio Area. The plan record does not require referrals. Its listed inpatient copay stages total $2,310 across 7 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$0 copay
Specialist
$40 copay
Laboratory services
$0 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0–$100 copay
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
$0–$330 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$130 copay
Listed inpatient stages
$2,310 total

7 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Greater Central Ohio Area (OH)
Plan type
HMOPOS
Contract / plan
H0628-017
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$40 copay
Vision$0 copay
Hearing$0 copay
Fitness & wellness$0 copay
Meals$0 copay

Plan-specific answers

Frequently asked questions

Where is H0628-017-000 available?

Aetna Medicare Signature Care (HMO-POS) is listed for Greater Central Ohio Area (OH). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H0628-017-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $5,500. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H0628-017-000?

The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H0628-017-000?

The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.

Does H0628-017-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.

Carrier-hosted source material

Official plan documents

An exact direct document has not been verified for this plan yet. Use the carrier's document finder and confirm H0628-017-000 before relying on a document.

Aetna plan document finder Search on the official carrier site ↗

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H0628-017-000 fits

Full CMS plan ID
H0628-017-000
Contract
H0628
Base plan code
H0628-017
Segment
000
Carrier
Aetna Medicare
Plan type
HMOPOS
Service area
Greater Central Ohio Area (OH)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Athens, OH
  • Delaware, OH
  • Fairfield, OH
  • Franklin, OH
  • Gallia, OH
  • Guernsey, OH
  • Jackson, OH
  • Knox, OH
  • Lawrence, OH
  • Licking, OH
  • Madison, OH
  • Marion, OH

12 additional service-area entries are retained in the data record.

Same CMS contract

H0628-001-000 Aetna Medicare Signature Care (HMO-POS) Toledo Area · HMOPOS H0628-003-000 Aetna Medicare Signature Extra (HMO-POS) Cincinnati Dayton OH Metro Area · HMOPOS H0628-005-000 Aetna Medicare Signature Care (HMO-POS) Greater Cleveland Area · HMOPOS H0628-019-000 Aetna Medicare Enhanced (HMO-POS) Greater Central Ohio Area · HMOPOS H0628-021-000 Aetna Medicare Signature (HMO-POS) Greater Cincinnati Dayton OH Area · HMOPOS H0628-027-000 Aetna Medicare Enhanced (HMO-POS) Cincinnati Dayton OH Area · HMOPOS H0628-013-000 Aetna Medicare Dual Care (HMO D-SNP) Ohio · HMO H0628-018-000 Aetna Medicare Longevity (HMO I-SNP) Select Counties in Ohio · HMO

About this code

What H0628-017-000 identifies

H0628-017-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H0628-017, H0628 017, or the compact full CMS ID H0628017000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.