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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 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 has an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail order services. This zero-dollar cost-sharing applies to one-month, two-month, and three-month supplies of these generic medications. For higher-tier medications, your costs are based on a percentage of the drug cost. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail order fills. Tier 5 specialty drugs also have a 25% coinsurance for standard pharmacy and mail order fills, which is restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Select (HMO D-SNP) offers medical coverage with no copay for primary care visits and a $20 copay for specialists. Inpatient hospital stays require a $150 copay for days one through five followed by no copay for days six through 90, while emergency care carries a $115 copay that is waived if you are admitted. Most outpatient, diagnostic, and home health services require no coinsurance and feature no copay for many baseline services. This plan also provides valuable supplemental benefits, including no copays for routine vision and hearing exams, a $300 annual eyewear allowance, and up to $2,500 in dental care with no copay for preventive services. Additionally, members receive up to 48 one-way transportation trips per year and a $215 monthly over-the-counter item reimbursement with no copay. While durable medical equipment and home health care have no copay or coinsurance, select services like dialysis and air ambulance require a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital care under Aetna Medicare Dual Select (HMO D-SNP) is covered with no coinsurance and requires a $150 copay for days 1 through 5, followed by no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $150, observation services carry a $150 copay per stay, and outpatient substance abuse sessions have a $10 to $15 copay, with prior authorization required for most services.
Partial Hospitalization See details
Aetna Medicare Dual Select (HMO D-SNP) covers partial hospitalization services with a copay of either $55.00 or $110.00 and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under Aetna Medicare Dual Select (HMO D-SNP), with ground ambulance services requiring a $225 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are also partially covered, offering up to 48 one-way trips per year to plan-approved locations with no copay and no coinsurance, though 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, with the copay 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 copays or coinsurance up to a $250,000 maximum limit.
Primary Care See details
Aetna Medicare Dual Select (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Therapy and mental health services are also covered with copays ranging from $5 to $15 and no coinsurance, while chiropractic services are partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for most covered services, such as annual physicals and health education, though kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered under this plan 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
Hearing services are 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 partially covered with no copay or coinsurance up to $1,250 per ear annually, but OTC hearing aids and 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 copay, no coinsurance, and no deductible for covered care. The plan offers a $300 annual maximum for eyewear, covering contact lenses, upgrades, and up to two pairs of eyeglasses (lenses and frames) per year, alongside routine and diabetic eye exams, though 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 Medicare-covered services requiring a $20 copay and no coinsurance, and other covered services offering no copay and no coinsurance up to a $2,500 annual limit. Fluoride treatment, other preventive dental, maxillofacial prosthetics, implant services, 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 and no coinsurance, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Dual Select (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Dual Select (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, 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), featuring no coinsurance for diagnostic services, no copay for lab services, and copays ranging from $0 to $40 for diagnostic tests. Outpatient X-rays and diagnostic radiological services have no copay, while therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization and referrals required for all services.
Home Health Services See details
Home health services are covered under 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 copayment and no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 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) offers partial coverage for other services with no copay and no coinsurance, including a $215 monthly over-the-counter item reimbursement, meal benefits for chronic illness, and select wellness exams and screenings. Acupuncture is not covered under this plan's other services benefit.
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