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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 South 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 $3900.00 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) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using a preferred pharmacy or preferred mail-order service. If standard pharmacies or standard mail-order services are used, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2, depending on the supply duration. For higher-tier medications, members pay a percentage of the drug cost through coinsurance instead of a flat copayment. Tier 3 preferred brands carry a 25% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 30% coinsurance across all pharmacy and mail-order options. The 30% coinsurance for Tier 5 specialty drugs applies strictly to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive coverage with many essential medical services requiring no copays or coinsurance. Beneficiaries pay no copay for primary care, specialist visits, routine preventive services, and home health care. For hospital stays, there is no coinsurance, though inpatient visits require a $165 daily copay for the first six days, and emergency room visits carry a $150 copay. This plan also features robust supplemental benefits, including dental, vision, and hearing coverage with no copays or coinsurance, subject to annual limits such as a $2,000 dental allowance and a $300 eyewear allowance. Additionally, members receive a $60 monthly allowance for over-the-counter items and pay no copay for medical equipment, although certain durable medical equipment requires a 0% to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $165 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and additional hospital days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, featuring a $0 to $150 copay for hospital outpatient services and a $165 copay per stay for observation services. Ambulatory surgical center visits, outpatient substance abuse sessions, and outpatient blood services are covered with no copay and no coinsurance.
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 benefits.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $150 to $225. These cost-sharing expenses do not count toward any plan-level deductible.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care, specialist, therapy, podiatry, and mental health services with no copay and no coinsurance. Telehealth benefits are available with no copay and a 20% coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, and select screenings, while kidney disease education requires a referral and a 20% coinsurance with no copay. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, 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, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring no copays, no coinsurance, and no deductibles for routine hearing exams, fitting evaluations, and prescription hearing aids up to a $1,000 maximum per ear every year. However, over-the-counter (OTC) hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered vision services with no copay and no coinsurance for covered exams and eyewear, including a $300 annual allowance. Covered benefits include annual routine eye exams and eyeglasses (lenses and frames), but individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance up to a maximum annual benefit of $2,000. Covered services include cleanings, exams, and restorative care, but fluoride treatments, other preventive 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 Chronic Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs require 0% to 20% coinsurance with no copay, while Part B insulin drugs have a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers medical equipment with no copays, although prior authorization is required for most services. Durable medical equipment carries a 0% to 20% coinsurance and prosthetic devices require a 20% coinsurance, while medical supplies and diabetic equipment have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Aetna Medicare Chronic Care (HMO C-SNP) plan, featuring no copay for lab services and a $0 to $25 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services start at a $0 copay, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance, with prior authorization and referrals required.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under Aetna Medicare Chronic Care (HMO C-SNP), though a referral is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (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, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring no copay and no coinsurance for chronic illness meal benefits, annual wellness exams, additional gFOBT and FIT screenings, and up to $60 monthly in over-the-counter item reimbursements. Acupuncture is not covered under this plan.
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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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