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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 North FL, Treasure Coast 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 drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month supplies at standard pharmacies and 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, or $30 for a three-month supply. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all supply durations. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply. These cost-sharing rates apply to both standard pharmacy pickups and standard mail-order services.
Additional Benefits
The Aetna Medicare Dual Select (HMO D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits and routine preventive services. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for days six through 90. Specialist visits, urgent care, and outpatient services generally require low copays ranging from no copay to $20, while emergency room visits carry a $115 copay that is waived upon admission. This plan also provides robust supplemental benefits, including no copay or coinsurance for routine vision and hearing exams, alongside a $400 annual eyewear allowance and a $1,000 annual per-ear hearing aid allowance. Dental care is covered with no copay up to a $2,500 annual limit, and members receive up to 48 free one-way trips to approved health locations. Additionally, the plan includes durable medical equipment at no cost and up to $190 monthly for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Dual Select (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 to 5 and no copay for days 6 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are provided at no copay.
Outpatient Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services, a $150 copay per stay for observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services are also covered with no coinsurance, requiring a $20 copay for individual sessions and a $15 copay for group sessions.
Partial Hospitalization See details
Aetna Medicare Dual Select (HMO D-SNP) covers partial hospitalization services with a copayment of either $55.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers ambulance services with a $250 copay for ground transit and 20% coinsurance for air transit, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are 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, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum benefit of $250,000.
Primary Care See details
Primary care services are covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for primary care doctor visits. Specialist, physical therapy, and occupational therapy visits require a $20 copay and no coinsurance, while chiropractic care is partially covered (excluding other chiropractic services) with copays up to $15 and no coinsurance. Other services like mental health, podiatry, and telehealth require copays from $0 to $20 and coinsurance up to 20%.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Select (HMO D-SNP), offering an annual physical exam, glaucoma screenings, and select supplemental benefits like health education and fitness with no copay and no coinsurance. Kidney disease education is covered with no copay but requires a 20% coinsurance and a referral, while several services—including medical nutrition therapy, weight management, alternative therapies, and in-home support—are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Select (HMO D-SNP), featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay, no coinsurance, and no deductible, featuring a $400 annual limit for eyewear. This benefit includes routine and diabetic eye exams, contact lenses, and up to three pairs of eyeglasses per year, but 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), offering Medicare-covered dental with a $20 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,500 annual maximum. Fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by 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 (DME), prosthetics, and medical supplies, with no copay and no coinsurance, though prior authorization is required. Diabetic supplies also have no coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Dual Select (HMO D-SNP) plan, with prior authorization and referrals required for services. Diagnostic tests have no coinsurance, featuring no copay for lab work and copays from $0 to $75 for procedures, while radiological services require a minimum 20% coinsurance for therapeutic services and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance with a referral, meaning some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Select (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without needing a prior three-day hospital stay. You pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Select (HMO D-SNP) partially covers other services with no copays and no coinsurance, though acupuncture is not covered. Covered supplemental benefits include a chronic illness meal benefit, annual wellness exams and screening mammography, additional gFOBT and FIT, and up to $190 monthly in reimbursement for over-the-counter items.
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