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Aetna Medicare Assure 1 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure 1 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Assure 1 (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure 1 (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in Kentucky. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure 1 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Assure 1 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Assure 1 (HMO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Assure 1 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Assure 1 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs according to the plan's formulary until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you will pay $48.50 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure 1 (HMO D-SNP) plan provides a range of benefits with varying cost-sharing. Hospital stays have a $2005 copay per admission, while emergency services have a $110 copay. Outpatient services, including primary care, specialist visits, and other therapies, often have a 20% coinsurance. Preventive services, such as an annual physical exam, are offered with no copay, along with other benefits like hearing and vision services with $0 copays for routine exams and coverage for hearing aids and eyewear. The plan also covers dental services with no copay for many preventive and restorative services, and offers coverage for home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $2005 per admission or stay. Additional days for Inpatient Hospital-Acute and Psychiatric, non-Medicare covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance, with the first three pints of blood covered. Individual and group sessions for outpatient substance abuse also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure 1 (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and Air Ambulance Services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Assure 1 (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. For Primary Care Physician Services and Chiropractic Services, there is a 20% coinsurance. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance, and Routine Foot Care is the only covered service. Other Health Care Professional services have a 0% to 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
The Aetna Medicare Assure 1 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams, which have a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription Hearing Aids are covered with a maximum benefit of $2000.00 every year, with no copay for Prescription Hearing Aids (all types).
Vision Services See details
Vision Services includes coverage for eye exams with a 20% coinsurance, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is covered with a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum plan benefit of $505 per year.
Dental Services See details
Dental services are covered with a 20% coinsurance for Medicare Dental Services, but other dental services have a maximum benefit of $3,500 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure 1 (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost sharing. Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered with a coinsurance of at most 20%. Therapeutic Radiological Services and Outpatient X-Ray Services are covered with a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% with a minimum of 0%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure 1 (HMO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure 1 (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available within the plan details.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and Other 1 and Other 2 with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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