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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 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 (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 has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when utilizing preferred pharmacies or preferred mail-order services, compared to a $2 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a one-month supply at preferred pharmacies and a $12 copay at standard pharmacies. For higher-tier medications, cost-sharing is structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance regardless of the pharmacy type. Utilizing preferred network pharmacies and mail-order services is the most cost-effective way to fill prescriptions under this plan.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. For specialized medical needs, members pay no coinsurance and low copays, including a $0 to $25 copay for specialists and a $130 copay for emergency room visits. 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 everyday health benefits, such as routine vision and hearing exams with no copay, alongside a $1,000 annual hearing aid allowance per ear. Preventive dental care is fully covered with no copay or coinsurance, while comprehensive dental services have no copay and a 20% to 50% coinsurance up to a $2,000 yearly limit. Additionally, members receive up to a $40 monthly allowance for over-the-counter items and pay no copay or coinsurance for diabetic equipment and supplies.
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. Prior authorization is required, and certain services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient hospital services with a $0 to $325 copay and observation services with a $325 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and 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 services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring 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 ambulance services, while transportation to plan-approved or health-related locations is not covered.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency room visits with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency coverage is also provided up to a $250,000 maximum limit with no coinsurance, requiring a $130 copay for emergency and urgent care, and a $250 copay for emergency transportation.
Primary Care See details
Primary care benefits under Aetna Medicare Chronic Care (HMO C-SNP) feature no copay and no coinsurance for primary care physician visits and routine podiatry, though chiropractic services are not covered. Other covered services like physical therapy, specialists, and mental health care have copays ranging from $0 to $25 with no coinsurance, while telehealth services require a 20% coinsurance and a copay of $0 to $50.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) features partially covered preventive services, offering annual physicals, health education, fitness benefits, and screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Medicare-covered hearing exams with a $25 copay and no coinsurance, while annual routine hearing exams and fitting evaluations are fully covered with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum benefit per ear every year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers vision services with no deductibles and no coinsurance, offering annual routine eye exams and follow-up diabetic eye exams for no copay. Medicare-covered eye exams have a copay ranging from $0 to $25, and prescription eyewear is covered with no copay up to a $125 annual maximum.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered dental services, featuring no copay and no coinsurance for preventive care, and no copay with 20% to 50% coinsurance for comprehensive care up to a $2,000 annual limit. Medicare-covered dental services require a $25 copay and no coinsurance, while 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 under the Aetna Medicare Chronic Care (HMO C-SNP) plan 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 a coinsurance of 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. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers durable medical equipment and medical supplies with no copay and coinsurance ranging from no coinsurance to 20%. Prosthetic devices are covered with no copay and 20% coinsurance, while diabetic equipment and supplies are fully covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required. Diagnostic tests feature no coinsurance and a copay of $0 (no copay) to $20, lab services have no copay, outpatient X-rays require a $20 copay and coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides coverage for cardiac rehabilitation services with no copay and no coinsurance, though only some services are covered as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and Supervised Exercise Therapy (SET) for symptomatic Peripheral Artery Disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Chronic Care (HMO C-SNP) 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 while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services, offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional colorectal screenings, and up to $40 monthly for over-the-counter items. Acupuncture, meal benefits, and Dual Eligible SNP services are not covered under this plan.
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