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Aetna Medicare Assure Value (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Value (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 Assure Value (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Value (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Virginia. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Value (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 Assure Value (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 Assure Value (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 Assure Value (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.80. 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 $590.00 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 $9350.00 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 Assure Value (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your prescriptions based on the drug tier and pharmacy you use until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $27.80. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure Value (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a high copay of $1880 per admission, while emergency services have a $110 copay, and urgent care has a $45 copay. Many services, including ambulance transport to health-related locations, home health, hearing exams, and dental services, have no copay. The plan covers a variety of outpatient, primary care, and preventive services, often with a 20% coinsurance, but some have no copay. Additionally, the plan includes coverage for hearing aids up to $2,500 per year, vision care including eye exams and eyewear, and also covers home infusion and dialysis services. Other benefits include OTC items, meal benefits, and skilled nursing facilities, some of which have no copay and some of which have a copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services, each with a copay of $1880 per admission or stay. Additional days, and non-Medicare-covered stays for both acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services are covered under the Aetna Medicare Assure Value (HMO D-SNP) plan, with all outpatient hospital services, observation services, and outpatient blood services subject to a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered, with a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure Value (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services; transportation services to a plan-approved health-related location are covered with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, but Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure Value (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Mental health specialty services, psychiatric services, and opioid treatment services have a 20% coinsurance. Additional telehealth benefits have a 20% coinsurance and a copay between $0.00 and $45.00. Podiatry services have a 20% coinsurance and no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services with a copay that varies by service. Kidney disease education and other preventive services such as glaucoma screenings have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids, with routine hearing exams and fitting/evaluation for hearing aids having no copay and at most 20% coinsurance for routine hearing exams. Prescription hearing aids have a maximum benefit of $2,500 per year, with no copay. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Assure Value (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and no copay for routine eye exams and other eye exam services, and eyewear with a 20% coinsurance and a $300 combined maximum benefit for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay.
Dental Services See details
The Aetna Medicare Assure Value (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), and implant services are covered with no copay. Maxillofacial prosthetics and orthodontics are not covered, and oral and maxillofacial surgery has a limit of one visit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure Value (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance with no copay. Diabetic Equipment is covered with a coinsurance, and Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, with no copay for either.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Assure Value (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Value (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Assure Value (HMO D-SNP) plan, but none of the sub-services are covered. Since there is no information about copays or coinsurance, there is no cost to the member for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Assure Value (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits, both with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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