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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 Southwest 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 Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members benefit from no copay for one-month, two-month, or three-month supplies. This zero-dollar coverage applies to prescriptions filled through both standard pharmacies and standard mail order. For higher-tier medications, coverage transitions to a coinsurance structure. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred Drug) medications carry a 25% coinsurance. Tier 5 (Specialty Tier) drugs also require a 25% coinsurance for a one-month supply filled via standard pharmacies or standard mail order.
Additional Benefits
The Aetna Medicare Dual Select (HMO D-SNP) offers robust healthcare coverage with many essential services featuring no copay and no coinsurance, including primary care visits, medical equipment, and home health services. For inpatient hospital stays, members pay a $175 daily copay for days 1 through 6 and no copay for days 7 through 90, while emergency room visits require a $115 copay that is waived if admitted. Outpatient hospital services range from no copay up to a $190 copay, ensuring predictable costs for major medical needs. In addition to medical care, this plan provides valuable supplemental benefits including a $192 monthly over-the-counter reimbursement and no copay for up to 48 one-way transportation trips to approved locations. Members also enjoy dental, vision, and hearing coverage with no copay for routine exams, plus generous annual allowances like $2,500 for dental services and $400 for eyewear. Skilled nursing facility care is covered with no copay for the first 20 days, requiring a $218 daily copay for days 21 through 100.
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. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers outpatient services with no coinsurance, although prior authorization is required for most treatments. Patients pay no copay for ambulatory surgical center and blood services, while outpatient hospital services range from a $0 to $190 copay, observation services cost a $175 copay per stay, and outpatient substance abuse sessions require a $15 to $20 copay.
Partial Hospitalization See details
Aetna Medicare Dual Select (HMO D-SNP) covers partial hospitalization services with no coinsurance and a copay of either $55.00 or $110.00, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Aetna Medicare Dual Select (HMO D-SNP) plan, with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, providing 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 require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Dual Select (HMO D-SNP) primary care benefits feature no copay and no coinsurance for primary care physician visits. Other covered services, such as specialist visits, physical therapy, and mental health services, have copays ranging from $0 to $25 with no coinsurance, while chiropractic care is only partially covered.
Preventive Services See details
Preventive Services offered by Aetna Medicare Dual Select (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for annual physicals, select supplemental benefits, and routine screenings. However, kidney disease education requires a 20% coinsurance with no copay, and several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 partially covered by Aetna Medicare Dual Select (HMO D-SNP), offering Medicare-covered exams for a $25 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,000 maximum per ear every year, but 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 copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam per year, unlimited follow-up diabetic eye exams, and up to $400 annually for contact lenses, upgrades, and up to three pairs of eyeglasses (lenses and frames), while 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), featuring Medicare-covered dental services for a $25 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,500 annual maximum. Specific services not covered under this plan include fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
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, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Select (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and no coinsurance. Prior authorization is required for these services, 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 prior authorization and referrals required. Lab services feature no copay and no coinsurance, diagnostic procedures have a copay ranging from $0 to $100 with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Select (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Dual Select (HMO D-SNP) with no copay, no coinsurance, and a referral requirement. While some services are covered, 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 no prior three-day hospital stay. You will 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
Other services are partially covered by Aetna Medicare Dual Select (HMO D-SNP) with no copay and no coinsurance for covered benefits, which include a $192 monthly over-the-counter reimbursement, chronic illness meal benefits, annual wellness exams, and additional cancer screenings. Acupuncture is not covered under this plan.
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