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Aetna Medicare Dual Select (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Select (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 Dual Select (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Select (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South FL, Treasure Coast FL, West FL. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Select (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 Dual Select (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 Dual Select (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 Dual Select (HMO D-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 $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 Dual Select (HMO D-SNP) plan features an annual prescription drug deductible of $615. For those looking to save on common medications, this plan offers no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order for one, two, or three-month supplies. For higher-tier medications, cost-sharing is based on 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 carry a 25% coinsurance when using standard pharmacies or standard mail order. These coinsurance rates apply to one, two, or three-month supplies, with Tier 5 specialty medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Select (HMO D-SNP) offers comprehensive coverage for essential medical services, with many benefits requiring no copayments or coinsurance. You will pay no copay or coinsurance for primary care, specialist visits, outpatient hospital services, and home health care. For inpatient hospital stays, there is no coinsurance, but you will pay a daily copay of $75 for the first six days and no copay for additional days. This plan also includes valuable supplemental benefits to help manage your everyday health costs. Dental services are covered up to $3,000 annually, vision benefits provide up to $400 yearly for eyewear, and hearing coverage includes up to $1,500 per ear for hearing aids with no copays or coinsurance. Additionally, members receive up to 48 one-way transportation trips per year and an $80 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
Aetna Medicare Dual Select (HMO D-SNP) covers inpatient acute hospital stays with no coinsurance, requiring a $75 daily copay for days 1 through 6 and no copay for days 7 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, requiring a $70 daily copay for days 1 through 6 and no copay for days 7 through 90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, with no copays and no coinsurance. Prior authorization is required for most of these outpatient services, but there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Dual Select (HMO D-SNP) covers partial hospitalization services with no coinsurance and either no copay or a $110 copay. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers ground ambulance services with a $100 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services and worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Dual Select (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and no coinsurance. Chiropractic care is partially covered, providing up to 24 routine visits per year with no copay or coinsurance, while other chiropractic services are not covered. Additional telehealth benefits are also available with no copay and a 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for annual physicals and most screenings, while kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers hearing exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance, offering up to $1,500 of coverage per ear annually. However, this benefit is only partially covered, as OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copays, no coinsurance, and no deductibles, offering one routine eye exam annually and up to $400 per year for eyewear. While contact lenses and eyeglasses (lenses and frames) are covered, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance up to a maximum annual benefit of $3,000. Covered services include cleanings, exams, and restorative work, while fluoride treatments, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% (no coinsurance) to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Dual Select (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Select (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with no copays and no coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for lab services and diagnostic tests. Outpatient X-rays and diagnostic radiology have no copays, while therapeutic radiology requires a minimum 20% coinsurance; referrals and prior authorizations are required for all services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance, although a referral is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a daily copay of $218 for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for all covered benefits. Covered options include an $80 monthly over-the-counter item reimbursement, meals for chronic illnesses, and wellness screenings, while acupuncture is not covered.
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