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Aetna Medicare Advantra Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Dual (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 Advantra Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Dual (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 Advantra Dual (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 Advantra Dual (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 Advantra Dual (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 Advantra Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order for up to a three-month supply. This ensures that essential maintenance medications remain highly affordable for plan members. For brand-name and specialty drugs, cost-sharing is based on a percentage of the drug cost rather than a flat fee. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty medications. These coinsurance rates apply to both standard retail pharmacy and standard mail order services.
Additional Benefits
The Aetna Medicare Advantra Dual (HMO D-SNP) provides robust medical coverage, featuring no copays for primary care visits, specialist consultations, and home health services. For hospital care, inpatient stays require a $1,865 copayment per stay with no coinsurance, while outpatient hospital services and diagnostic tests generally have no copay and a 20% coinsurance. Emergency room visits carry a $115 copay that is waived upon admission, while urgent care services require a $40 copay. In addition to medical care, the plan offers dental coverage up to a $1,500 annual limit and prescription hearing aids up to $500 per ear with no copays. Members also benefit from vision care with no copays for routine exams and up to $300 annually for eyewear, alongside up to 24 one-way transportation trips per year with no copay. Other valuable perks include a $175 monthly over-the-counter reimbursement and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a copayment of $1,865 per stay and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers outpatient services with no copayments, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers partial hospitalization services, subject to prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Advantra Dual (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Advantra Dual (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, while urgent care has a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Primary care and specialist services under Aetna Medicare Advantra Dual (HMO D-SNP) are covered with no copays and coinsurance ranging from no coinsurance to 20%. Other benefits like physical, occupational, and mental health therapies also require no copay and 20% coinsurance, while routine chiropractic care is not covered.
Preventive Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) partially covers preventive services, offering annual physical exams and select supplemental benefits with no copay and no coinsurance. A 20% coinsurance with no copay applies to services like kidney disease education and glaucoma screenings, while certain options like weight management, therapeutic massage, and in-home support services are not covered.
Hearing Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) provides partially covered hearing services with no deductible, featuring annual routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered under the Aetna Medicare Advantra Dual (HMO D-SNP) plan with no deductibles, offering annual routine eye exams and follow-up diabetic eye exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is covered up to $300 annually with no copay for eyeglasses, frames, lenses, and upgrades, while contact lenses require a 20% coinsurance and no copay.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Dual (HMO D-SNP), with Medicare-covered dental requiring no copay and 20% coinsurance, and other dental services covered with no copay and no coinsurance up to a $1,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra Dual (HMO D-SNP) with no copay, though prior authorization is required. Part B insulin drugs under this benefit have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers medical equipment, including DME, prosthetics, and diabetic supplies, with prior authorization required. Covered durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance and no copay, while diabetic supplies feature no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Advantra Dual (HMO D-SNP) plan with no copay, subject to a 20% coinsurance and prior authorization. Covered services include all Medicare-covered diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers some cardiac rehabilitation services with no copay, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Advantra Dual (HMO D-SNP) with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and additional days beyond standard Medicare-covered services are not covered.
Other Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, offering benefits like a $175 monthly over-the-counter reimbursement, chronic illness meals, and additional wellness and cancer screenings. Acupuncture and highly integrated services for dual-eligible SNPs are not covered under this plan.
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