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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (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 (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Greater Cleveland 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 (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 (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 (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 (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6750.00 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 (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $2 copay for a one-month supply. For Tier 2 generic drugs, you will pay a $5 copay at preferred locations or a $12 copay at standard locations for a one-month supply. For brand-name and specialty medications, the plan transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail order channels. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, ensuring consistent cost-sharing regardless of your choice of pharmacy.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers affordable access to essential medical services, featuring no copays and no coinsurance for primary care doctor visits and annual physicals. For specialized care, specialist visits range from no copay to a $25 copay, while emergency room visits require a $130 copay that is waived if you are admitted. Inpatient hospital stays require a $325 daily copay for the first six days, after which there is no copay for days 7 through 90. This plan also includes valuable supplemental coverage, such as preventive dental and routine hearing and vision exams with no copays. Additionally, members benefit from up to $2,000 annually for comprehensive dental services with no copay and 20% to 50% coinsurance, alongside a $40 monthly over-the-counter reimbursement. Durable medical equipment and diabetic supplies are covered with no copays, though some medical equipment requires up to a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as additional days, non-Medicare-covered stays, and acute upgrades are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay or coinsurance, while outpatient substance abuse services require a $25 copay per individual or group session with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Chronic Care (HMO C-SNP) covers partial hospitalization services with a copay of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $130 to $250.
Primary Care See details
Primary care benefits under Aetna Medicare Chronic Care (HMO C-SNP) feature no copay and no coinsurance for primary care doctor visits, and a $0 to $25 copay with no coinsurance for specialists. Therapy services, including physical, occupational, and mental health, require a $25 copay and no coinsurance, while some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services under the Aetna Medicare Chronic Care (HMO C-SNP) plan feature no copay and no coinsurance for annual physicals and screenings, while kidney disease education has no copay and a 20% coinsurance. Additional preventive benefits are partially covered, excluding in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Medicare-covered hearing exams for a $25 copay and no coinsurance, while routine exams and fitting evaluations are covered annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear each year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers vision services with no deductibles or coinsurance, offering eye exams with a $0 to $25 copay, which includes one routine annual exam and follow-up diabetic exams with no copay. Eyewear, including contacts, lenses, frames, and upgrades, is also covered with no copay up to a combined maximum benefit of $225 per year.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), offering Medicare-covered dental for a $25 copay and no coinsurance, and preventive services with no copay and no coinsurance. Comprehensive services are covered up to $2,000 annually with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copays across all categories, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME and medical supplies have a coinsurance of 0% to 20%, prosthetic devices require a 20% coinsurance, and diabetic equipment features no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required. Lab services have no copay or coinsurance, other diagnostic tests range from no copay to a $20 copay with no coinsurance, and radiological services range from a $0 minimum copay up to a 20% coinsurance for therapeutic services and a $20 copay plus coinsurance for X-rays.
Home Health Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers coverage for home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) has no copay and no coinsurance for cardiac rehabilitation, where some services are covered, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services with no copay and no coinsurance, which includes an annual wellness exam, screening mammography, additional gFOBT and FIT screenings, and a $40 monthly over-the-counter reimbursement. Acupuncture, meal benefits, and dual eligible SNP services are not covered.
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