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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, Central 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) features an annual prescription drug deductible of $615. For generic medications, this plan offers savings with no copay for Tier 1 preferred generics and Tier 2 generics filled through standard pharmacies or standard mail order. This cost-sharing benefit applies to one-month, two-month, and three-month supply options. For brand-name and specialty drugs, costs are 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 under standard pharmacy and standard mail order options. Specialty tier medications are limited to a one-month supply at this 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Dual Select (HMO D-SNP) offers comprehensive medical coverage featuring no copay for primary care visits and a $20 copay for specialists. Inpatient hospital stays require a $175 daily copay for days one through six and no copay for remaining days, while outpatient hospital services feature no coinsurance and copays up to $175. Emergency care is covered with a $115 copay, which is waived if you are admitted within 24 hours, and urgent care requires a $30 copay. Additionally, the plan provides excellent supplemental benefits including no copays or coinsurance for routine dental, vision, and hearing exams, alongside generous allowances for eyewear and hearing aids. Members also receive no-copay home health care, up to 48 free one-way trips to plan-approved locations, and a monthly allowance of up to $185 for over-the-counter items. Most durable medical equipment and preventive services are also fully covered with no copays or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Select (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $175 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $175 copay for outpatient hospital services and a $175 copay per stay for observation services. Outpatient substance abuse services require a $10 copay per individual or group session, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Aetna Medicare Dual Select (HMO D-SNP) covers partial hospitalization services with a copay of either $30.00 or $110.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers ambulance services with a $240 copay for ground transport and a 20% coinsurance for air transport. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, but 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, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $30 copay, with no coinsurance for either service. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $250,000.
Primary Care See details
Aetna Medicare Dual Select (HMO D-SNP) covers primary care provider services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Chiropractic services are partially covered with a $0 to $15 copay and no coinsurance, excluding other chiropractic services, while telehealth services are available with a $0 to $30 copay and 20% coinsurance.
Preventive Services See details
Preventive services under Aetna Medicare Dual Select (HMO D-SNP) are partially covered, offering no copay and no coinsurance for annual physicals, routine screenings, and select supplemental benefits like fitness programs. While several sub-services such as nutritional therapy, weight management, and in-home support are not covered, kidney disease education is covered with no copay and a 20% coinsurance.
Hearing Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers Medicare-covered hearing exams for a $20 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual maximum per ear, though inner ear, outer ear, over the ear, and OTC 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 exams and eyewear, including a $300 annual allowance for contacts or up to two pairs of eyeglasses. While routine eye exams and eyeglasses (lenses and frames) are covered, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Aetna Medicare Dual Select (HMO D-SNP) offers partially covered dental services, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $1,500 annual limit. Fluoride treatment, other preventive dental services, 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, though prior authorization is 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 require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Select (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment benefits under Aetna Medicare Dual Select (HMO D-SNP) generally require prior authorization and feature no copays or coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Diabetic therapeutic shoes and inserts are covered with a $10 copay and no coinsurance, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Dual Select (HMO D-SNP), though prior authorization and referrals are required. Lab services, diagnostic radiological services, and outpatient X-rays have no copay, while diagnostic procedures and tests have a copay ranging from $0 to $75 with no coinsurance. Therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Select (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, though a referral is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are 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, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare 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, though acupuncture is not covered. Covered benefits include chronic illness meals, annual wellness exams, screening mammography, additional colorectal screenings, and up to $185 per month in reimbursed over-the-counter items.
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