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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 Ohio. 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 $17.20. 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, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, you will pay a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier prescriptions, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for one-, two-, and three-month supplies. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Aetna Medicare Partial Dual (HMO D-SNP) offers comprehensive medical coverage where many routine services, including primary care, specialist visits, outpatient care, and medical equipment, feature no copay and a 20% coinsurance. For inpatient hospital stays, members pay no coinsurance but will have a copayment of $2,105 per stay for acute care or $2,080 per stay for psychiatric care. Emergency services require a $115 copay, which is waived if admitted within 24 hours, while urgently needed care carries a $40 copay. Additional benefits include preventive and comprehensive dental care up to a $2,500 annual limit and hearing aids up to $1,500 per ear with no copay and no coinsurance. Vision benefits feature an annual routine eye exam with a 20% coinsurance and a $375 annual limit on eyewear with no copay. Members also receive home health services with no copay or coinsurance, 12 one-way transportation trips per year, and a $100 monthly reimbursement for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Partial Dual (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring prior authorization and a copayment of $2,105 per stay for acute care or $2,080 per stay for psychiatric care. This benefit is partially covered as upgrades, additional days, 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, 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 outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Partial Dual (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either no copay and a 20% coinsurance, or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Aetna Medicare Partial Dual (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Partial Dual (HMO D-SNP) plan with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum limit.
Primary Care See details
Primary Care benefits under Aetna Medicare Partial Dual (HMO D-SNP) generally feature no copay and 20% coinsurance for primary care, specialists, physical therapy, and mental health services, though chiropractic services are not covered. Additional telehealth services are covered with a $0 to $40 copay and 20% coinsurance, while routine podiatry is covered for up to six annual visits with no copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP), offering no copay and no coinsurance for annual physical exams, and no copay with 20% coinsurance for kidney disease education and screenings. Sub-services not covered under this plan include medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services covered by the Aetna Medicare Partial Dual (HMO D-SNP) plan include fitting evaluations and prescription hearing aids with no copay and no coinsurance, up to a $1,500 limit per ear annually. Routine hearing exams are covered with no copay and a 20% coinsurance, but OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services covered by Aetna Medicare Partial Dual (HMO D-SNP) include one routine eye exam per year with no copay and a 20% coinsurance, alongside follow-up diabetic eye exams with no copay. Eyewear is also covered with no copay—except for contact lenses which carry a 20% coinsurance—up to a $375 annual limit with no deductibles.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP), offering an annual maximum benefit of $2,500 with no copay and no coinsurance for preventive and most comprehensive care, though Medicare-covered dental services require a 20% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Partial Dual (HMO D-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 Partial Dual (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay, while diabetic therapeutic shoes and inserts require a 20% coinsurance, with prior authorization required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Partial Dual (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay under the Aetna Medicare Partial Dual (HMO D-SNP) plan, though only some services are covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Partial Dual (HMO D-SNP) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Aetna Medicare Partial Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, providing a meal benefit for chronic illness, wellness exams, and a $100 monthly reimbursement for over-the-counter items. Acupuncture and highly integrated services for dual-eligible SNPs are not covered.
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