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Aetna Medicare Prime Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime 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 Prime Chronic Care (HMO C-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Chicago. The overall rating for this plan is not yet available for 2025.
It's important to know that Aetna Medicare Prime 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 Prime 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 Prime 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 Prime 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 $300.00 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 Prime Chronic Care (HMO C-SNP) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $5 copay at preferred pharmacies, and $12 at standard pharmacies. For preferred brand drugs, you'll pay 50% coinsurance regardless of the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan offers a range of benefits with varying costs. You'll find no copay for many services, including primary care physician visits, routine eye exams, and dental exams. Hospital stays have a copay, with additional costs for emergency services and some outpatient procedures. This plan provides coverage for a variety of services. You can expect no copay for some services, but others have copays or coinsurance. The plan offers coverage for hearing and vision services, home health, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $455 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $290, observation services with a $290 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $30 copay for individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, with a $60 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP). Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, while Worldwide Emergency Transportation has a $290 copay; all have no coinsurance. The copay for Emergency Services is waived if admitted to the hospital within 24 hours. Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
Primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary Care Physician Services have no copay, chiropractic services have a $20 copay, occupational therapy has a $30 copay, physician specialist services have a copay between $0 and $30, mental health specialty services have a $30 copay, podiatry services have no copay, other health care professional services have a copay between $0 and $30, psychiatric services have a $30 copay, physical therapy and speech-language pathology services have a $30 copay, additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55, and opioid treatment program services have a $30 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $1250 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $370 every year.
Dental Services See details
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan covers some dental services, including oral exams with no copay, and dental x-rays and cleanings with no copay. Other services, like fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics, are not covered. Restorative services, adjunctive general services, and endodontics have a 20-50% coinsurance, while prosthodontics (removable and fixed) has a 50% coinsurance, and oral and maxillofacial surgery has a 20-50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and a 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, and coinsurance for Medicare-covered items. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for various services, including a $20 copay for outpatient X-ray services and a maximum copay of $195 for diagnostic radiological services, and a coinsurance of up to 20% for therapeutic radiological services. Lab services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, although additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under "Other Services," acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items are covered with no copay, and a maximum benefit coverage amount of $35.00 every month. Meal benefits are covered with no copay. Other services, including annual wellness exams, screening mammography, gFOBT, and FIT, are covered with no copay.
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