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Aetna Medicare Chronic Care Total (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care Total (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care Total (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care Total (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Toledo Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care Total (HMO C-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 Chronic Care Total (HMO C-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 Chronic Care Total (HMO C-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 Chronic Care Total (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.60. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $615.00 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 $9250.00 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 Chronic Care Total (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic prescription copays start at $5.00 for a one-month supply at standard pharmacies and standard mail order, with three-month supplies costing $15.00 at standard pharmacies and $10.00 via standard mail order. For higher-tier medications, including Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, the plan requires a 25% coinsurance. This 25% coinsurance rate applies to one-, two-, and three-month supplies of Tier 3 and Tier 4 drugs at standard pharmacies and standard mail order. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care Total (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits and no copay alongside 0% to 20% coinsurance for specialist consultations. While inpatient hospital stays require a copay of either $2,230 for acute care or $2,080 for psychiatric care, outpatient hospital services feature no copays and up to 20% coinsurance. Emergency care is accessible with a $115 copay, while urgent care visits require a $40 copay, with no coinsurance for either service. For everyday wellness, the plan provides valuable supplemental benefits, including a $2,500 annual dental limit and a $350 eyewear allowance, both featuring no copays and no coinsurance for preventive care. Members also benefit from a monthly $200 allowance for over-the-counter items and up to $1,250 per ear annually for prescription hearing aids with no copays or coinsurance. Additionally, diagnostic labs, home health services, and the first 20 days of skilled nursing facility care are covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care Total (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by Aetna Medicare Chronic Care Total (HMO C-SNP) feature no copays, with coinsurance ranging from 0% to 20% depending on the service. While outpatient blood services have no copay and no coinsurance, other services like outpatient hospital, ambulatory surgical, and substance abuse services require prior authorization and carry up to a 20% coinsurance.
Partial Hospitalization See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers partial hospitalization with a copay of either $55.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Although transportation services are technically listed as covered, transportation to plan-approved or any other health-related locations is not covered in practice.
Emergency Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $250,000 maximum with a $115 copay and no coinsurance, while worldwide emergency transportation requires a 20% coinsurance and no copay.
Primary Care See details
Primary care benefits under Aetna Medicare Chronic Care Total (HMO C-SNP) feature no copay and no coinsurance for primary care provider visits, while specialist, therapy, and mental health services require no copay and a 0% to 20% coinsurance. Some chiropractic services are covered but routine and other chiropractic services are not covered, and telehealth benefits range from a $0 to $40 copay with 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Chronic Care Total (HMO C-SNP), offering no copay and no coinsurance for annual physical exams, health education, smoking cessation, fitness benefits, and remote access technologies. Kidney disease education, diabetes self-management training, glaucoma screenings, digital rectal exams, and post-welcome visit EKGs are covered with no copay and a 20% coinsurance. Several supplemental options are not covered under this plan, including in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Chronic Care Total (HMO C-SNP), offering one routine exam annually with a 20% coinsurance and no copay, alongside one fitting exam with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear each year with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care Total (HMO C-SNP) with no deductibles, offering routine and follow-up diabetic eye exams with no copay and 0% to 20% coinsurance. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $350 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care Total (HMO C-SNP), featuring a $2,500 annual maximum benefit. Medicare-covered dental services have no copay and 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers medical equipment, including durable medical equipment and medical supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prosthetic devices and diabetic therapeutic shoes or inserts are covered with a 20% coinsurance and no copays, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care Total (HMO C-SNP) with prior authorization and no copays. There is no coinsurance for diagnostic procedures, lab services, and diagnostic radiological services, while therapeutic radiological services and outpatient X-ray services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Aetna Medicare Chronic Care Total (HMO C-SNP), as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Chronic Care Total (HMO C-SNP) with no coinsurance and requires prior authorization, but does not require a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) partially covers other services with no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $200 monthly for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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