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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 Cincinnati Dayton 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:
Sign up for Aetna Medicare Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, while standard options charge a low copay starting at $2. Tier 2 generic drugs cost as low as a $5 copay for a one-month supply at preferred pharmacies, compared to a $12 copay at standard pharmacies. For brand-name and specialty medications, costs transition to coinsurance percentages. Tier 3 preferred brand drugs require a 22% coinsurance, whereas Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply across all pharmacy and mail order options.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, preventive screenings, annual physicals, and home health services. For inpatient hospital stays, members pay a daily copay of $325 for the first six days and no copay for days 7 through 90. Emergency room visits require a $130 copay, which is waived if you are admitted, while specialists and outpatient therapies carry low copays ranging from nothing to $25. This plan also includes key supplemental benefits, such as routine dental, vision, and hearing care with no copayments. You receive up to $225 annually for eyewear, up to $1,000 per ear for prescription hearing aids, and a $2,000 annual limit for comprehensive dental care with 20% to 50% coinsurance. Additionally, members can access covered diabetic supplies and select diagnostic services with no copay, alongside a monthly allowance of up to $40 for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90 for acute and psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, featuring copays ranging from $0 to $325 for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copays or coinsurance, while outpatient substance abuse sessions require a $25 copay 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 to access this benefit.
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. Prior authorization is required for all ambulance services, and transportation services are not covered.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays of $130 for emergency or urgent care and $250 for transportation.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) offers primary care physician visits and podiatry services with no copay and no coinsurance, while specialist visits range from no copay to a $25 copay with no coinsurance. Physical, occupational, speech, mental health, and opioid treatment therapies require a $25 copay and no coinsurance, whereas telehealth services have a $0 to $50 copay and 20% coinsurance. Some chiropractic services are covered, but routine and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physicals, health education, and screenings, while kidney disease education requires a 20% coinsurance and no copay. However, several sub-services are not covered, including personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and in-home support.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers hearing services, featuring Medicare-covered exams for a $25 copay and no coinsurance, as well as annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $1,000 per ear annually, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers vision services with no deductibles and no coinsurance, featuring a $0 to $25 copay for eye exams and no copay for routine eye exams. Covered eyewear, including contacts, eyeglasses, and upgrades, also has no copay and is subject to a $225 yearly maximum benefit.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides partially covered dental services featuring no copay and no coinsurance for preventive care, a $25 copay and no coinsurance for Medicare-covered services, and no copay with 20% to 50% coinsurance for comprehensive care up to a $2,000 annual limit. Fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Chronic Care (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 (HMO C-SNP) covers medical equipment with no copays, although coinsurance ranges from 0% to 20% for durable medical equipment and medical supplies, and is set at 20% for prosthetic devices. Diabetic equipment, supplies, and therapeutic shoes are fully covered with no copays and no coinsurance, though manufacturer limitations and prior authorizations may apply.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP), with prior authorization required for all services. Diagnostic tests require a $0 to $20 copay and no coinsurance, lab services and diagnostic radiology have no copay and no coinsurance, outpatient X-rays require a $20 copay, and therapeutic radiology carries a 20% coinsurance with no copay.
Home Health Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers 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) does not cover Cardiac Rehabilitation Services in practice, as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD rehabilitation are all not covered. Consequently, there is no copay or coinsurance coverage available for these services under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) care 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, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services, providing no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT, and over-the-counter items up to $40 per month. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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