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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in North FL. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 $200.00 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 $4200.00 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 Chronic Care (HMO C-SNP) plan features an annual drug deductible of $200. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using preferred pharmacies or preferred mail order services. If you choose standard pharmacies or standard mail order, Tier 1 drugs carry a copay starting at $2, while Tier 2 generics have a copay starting at $12 for a one-month supply. For higher-tier medications, the plan transitions to coinsurance across all pharmacy and mail order channels. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 30% coinsurance. Specialty drugs under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits and low specialist copays ranging from no copay to $20. For hospital care, inpatient stays require a $205 daily copay for the first five days with no copay thereafter, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient hospital services and home health care are highly affordable, featuring no coinsurance and mostly no copays for standard care. This plan also provides excellent supplemental benefits, including preventive dental care and routine vision exams with no copays and generous annual allowances, such as up to $1,500 for dental and $200 for eyewear. Additionally, members receive routine hearing exams and up to $1,000 per ear for hearing aids with no copay, alongside a $50 monthly over-the-counter allowance. Skilled nursing facility stays are also covered, featuring no copay for the first 20 days of your stay.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers inpatient hospital acute and psychiatric services with no coinsurance and a copay of $205 per day for days 1 through 5, followed by no copay for days 6 through 90. Prior authorization is required, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services range from no copay to a $205 copay, observation services require a $205 copay per stay, and outpatient substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Aetna Medicare Chronic Care (HMO C-SNP) covers partial hospitalization services with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $150 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency services are also covered up to a $250,000 maximum with no coinsurance, featuring a $150 copay for emergency and urgent care, and a $300 copay for emergency transportation.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $20 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies require a $10 copay with no coinsurance, telehealth services carry a $0 to $40 copay with 20% coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring no copays and no coinsurance for annual exams, health education, and fitness benefits, while kidney disease education requires no copay and a 20% coinsurance. However, several supplemental services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers hearing services, offering Medicare-covered exams for a $20 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered yearly with no copay and no coinsurance up to $1,000 per ear, though OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision Services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copays, no coinsurance, and no deductibles for routine eye exams, diabetic eye exams, and eyewear. While the plan covers contact lenses and up to two pairs of eyeglasses per year with a $200 annual maximum, individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers dental services with a $20 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services up to a $1,500 annual maximum. This benefit is partially covered, as fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Chronic Care (HMO C-SNP) with no copays, though prior authorization is required. Durable medical equipment incurs a 0% to 20% coinsurance, prosthetic devices require a 20% coinsurance, and medical supplies and diabetic equipment from specified manufacturers are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Chronic Care (HMO C-SNP), with prior authorization and referrals required. Lab services have no copay and no coinsurance, diagnostic tests range from a $0 to $75 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) notes some services are covered for cardiac rehabilitation with no copay and no coinsurance, but in practice, 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 covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Chronic Care (HMO C-SNP), featuring no copay and no coinsurance for chronic illness meals, select wellness screenings, and a $50 monthly over-the-counter reimbursement. Acupuncture is not covered under this benefit.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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