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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 2026, 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 Northern and Chicago. The overall rating for this plan is not yet available for 2026.
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 $200.00 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 features a $200 annual drug deductible. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service for any supply length. If you choose standard pharmacies or standard mail-order options, copays range from $2 to $12 for a one-month supply. For brand-name and specialty medications, your costs are based on a percentage of the drug cost. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 30% coinsurance across all pharmacy types. Specialty medications are limited to a one-month supply at these rates.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with low out-of-pocket costs, including no copay for primary care visits and a low $0 to $20 copay for specialists. Inpatient hospital stays require no coinsurance, with daily copays ranging from $325 to $375 for the first seven days and no copay for days eight through 90. Outpatient hospital services and emergency care are also highly accessible, featuring no coinsurance and copays of $130 for emergency visits and up to $375 for outpatient services. In addition to core medical care, this plan provides valuable supplemental benefits like no copay for routine vision, routine hearing, and preventive dental services. Members can benefit from a $200 annual eyewear allowance, up to $750 per ear annually for hearing aids, and a $40 monthly over-the-counter reimbursement. Covered home health services also carry no copay or coinsurance, helping you manage your health affordably from the comfort of your home.
Inpatient Hospital See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers inpatient hospital stays with no coinsurance, requiring a $375 copay for days 1 to 7 of acute stays and a $325 copay for days 1 to 7 of psychiatric stays, with no copay for days 8 to 90 for either stay type. Prior authorization is required, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Outpatient hospital services have a copay ranging from $0 to $375, observation services cost a $375 copay per stay, and substance abuse sessions have a $20 copay, while ambulatory surgical center and blood services are available with no copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan 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 Prime Chronic Care (HMO C-SNP) covers ambulance services with prior authorization, requiring a $290 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency and urgent care is covered up to $250,000 with copays ranging from $130 to $290 and no coinsurance.
Primary Care See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) provides primary care physician and routine podiatry visits with no copay and no coinsurance, while specialist visits require a $0 to $20 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services require a $20 copay and no coinsurance, telehealth services carry a $0 to $50 copay with 20% coinsurance, and some chiropractic services are covered but routine and other chiropractic care are not.
Preventive Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers preventive services with no copay and no coinsurance for annual physical exams, health education, and fitness benefits, though kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered, as services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear every year, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This coverage includes one routine eye exam per year, unlimited follow-up diabetic eye exams, and a $200 annual allowance for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), featuring Medicare-covered dental with a $20 copay and no coinsurance, alongside preventive care like cleanings and exams with no copay or coinsurance. Comprehensive benefits like endodontics and restorative services have no copay and 20% to 50% coinsurance up to a $2,500 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Covered Medicare Part B insulin has 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 Prime Chronic Care (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers medical equipment with no copays, although prior authorization is required. Diabetic equipment and supplies are offered with no coinsurance, while durable medical equipment and medical supplies carry a 0% to 20% coinsurance, and prosthetic devices require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and a $0 to $20 copay for diagnostic tests, alongside no copay for lab services. Diagnostic radiological services start at a $0 copay, outpatient X-rays require a $20 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, which offers no coverage for intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance for covered benefits, which include a $40 monthly over-the-counter reimbursement allowance, annual wellness exams, and additional gFOBT and FIT screenings. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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