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Aetna Medicare Advantra Cares (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Cares (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 Cares (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Cares (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 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Cares (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 Cares (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 Cares (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 Cares (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.90. 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 Advantra Cares (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs. The plan's formulary should be checked for specific drug costs. If you qualify for the low-income subsidy (LIS), you will pay $8.90 for Part D. After 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 Advantra Cares (HMO D-SNP) plan offers a range of benefits with varying costs. This plan covers inpatient hospital stays with a high copay, and outpatient services, including emergency services, with a coinsurance or copay. It also provides coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay or a coinsurance. Additional benefits include ambulance and transportation services, home health services, medical equipment, and diagnostic services. Many of these services have no copay or a 20% coinsurance. The plan also has a monthly allowance for over-the-counter items, but does not cover some services such as cardiac rehabilitation and certain types of long-term care.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each with a copay of $2185 and $2036 per admission or stay, respectively. Additional days, non-Medicare stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Outpatient Blood Services also has a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for ground and air ambulance services. Ground and air ambulance services have a 20% coinsurance, and Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, using rideshare, bus/subway, or medical transport. 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 by the Aetna Medicare Advantra Cares (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with 20% coinsurance, Chiropractic Services with 20% coinsurance (but not routine care), Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 0%–20% coinsurance, Mental Health Specialty Services with 20% coinsurance for individual and group sessions, Podiatry Services with 20% coinsurance and no copay for Medicare-covered services, Other Health Care Professional services with 0%–20% coinsurance, Psychiatric Services with 20% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with 20% coinsurance and a copay of $0.00–$45.00, and Opioid Treatment Program Services with 20% coinsurance.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services like Health Education, Nutritional/Dietary Benefits, and Wigs for Hair Loss Related to Chemotherapy with no copay. Additional services such as Glaucoma Screening, Diabetes Self-Management Training, and Digital Rectal Exams are covered with 20% coinsurance. Other services like In-Home Safety Assessment, Medical Nutrition Therapy, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, with a coinsurance of at most 20% for Routine Hearing Exams, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered with no copay, up to a maximum of $500 per year for Prescription Hearing Aids (all types).
Vision Services See details
Vision services include eye exams with a 20% coinsurance, routine eye exams with no copay, and other eye exam services with no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay, with a combined maximum of $300 every year.
Dental Services See details
The Aetna Medicare Advantra Cares (HMO D-SNP) plan covers dental services, including a 20% coinsurance for Medicare dental services. Other dental services have a $2,000 annual maximum benefit. Oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, other preventative services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have visit limits or other restrictions. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay. 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 Advantra Cares (HMO D-SNP) plan, but require prior authorization. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying cost sharing. DME for use outside the home is not covered, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. 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 under the Aetna Medicare Advantra Cares (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 not covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Advantra Cares (HMO D-SNP) plan, and prior authorization is required. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, Other 1, and Other 2. Over-the-Counter (OTC) Items have no copay, with a maximum plan benefit coverage amount of $150.00 every month. 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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