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Aetna Medicare Partial Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial Dual (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 Partial Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Select Counties in Kentucky. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Partial Dual (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 Partial Dual (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 Partial Dual (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 Partial Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 Partial Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail-order costs are a $10 copay for a 1-month supply, $20 for a 2-month supply, and $30 for a 3-month supply. For brand-name and specialty drugs, costs are based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a 1-month supply at standard pharmacies or standard mail order.
Additional Benefits
The Aetna Medicare Partial Dual (HMO D-SNP) offers comprehensive healthcare coverage with predictable out-of-pocket costs. Inpatient hospital stays require a $1,960 copay per stay with no coinsurance, while outpatient services and primary care visits feature no copay and up to a 20% coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, while urgently needed care requires a $40 copay. This plan also includes valuable supplemental benefits like dental, vision, and hearing coverage with no deductibles. Eyewear up to $275, fitting evaluations, and hearing aids up to $1,250 per ear are covered with no copay and no coinsurance, while other dental benefits are covered up to $1,850 annually. Additionally, members receive up to 12 one-way transportation trips per year and up to $100 monthly in over-the-counter item reimbursements with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Partial Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a copayment of $1,960 per stay and no coinsurance. This benefit is partially covered, as prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Aetna Medicare Partial Dual (HMO D-SNP) covers partial hospitalization services with prior authorization, costing either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations via rideshare, bus, subway, or medical transport with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Partial Dual (HMO D-SNP) with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed care requires a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance up to a maximum benefit of $250,000.
Primary Care See details
Aetna Medicare Partial Dual (HMO D-SNP) covers primary care, specialist, therapy, and psychiatric services with no copay and coinsurance ranging from no coinsurance up to 20%. Telehealth services require a $0 to $40 copay and 20% coinsurance, routine podiatry is limited to six visits per year with a 20% coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Partial Dual (HMO D-SNP) partially covers preventive services, offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and glaucoma screenings require no copay and a 20% coinsurance. Sub-services such as medical nutrition therapy, weight management, alternative therapies, in-home safety assessments, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP) with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Partial Dual (HMO D-SNP) with no deductible and a $275 annual maximum benefit for eyewear. Routine eye exams and contact lenses have no copay and a 20% coinsurance, while follow-up diabetic eye exams, eyeglasses, lenses, and frames feature no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Partial Dual (HMO D-SNP) plan, offering no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other dental benefits up to an annual limit of $1,850. While most preventive and comprehensive services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers home infusion bundled services 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 ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Partial Dual (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes or inserts require a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers diagnostic and radiological services with no copay, though prior authorization is required. Medicare-covered diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services feature no coinsurance.
Home Health Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Partial Dual (HMO D-SNP) with no copay, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Partial Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no 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 100 days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP) with no copay and no coinsurance for wellness exams, chronic illness meals, additional colon cancer screenings, and up to $100 monthly in over-the-counter item reimbursements. Acupuncture is not covered under this plan.
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