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Aetna Medicare Chronic Care (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (PPO 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 (PPO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (PPO C-SNP) is a PPO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Select Counties in Atlanta Metro. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (PPO 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 (PPO 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 (PPO 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 (PPO 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 $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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO C-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services, compared to a copay starting at $2 at standard pharmacies. Tier 2 generic drugs cost a $5 copay for a one-month supply at preferred pharmacies and preferred mail-order, while standard pharmacies and mail-order charge a $12 copay. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (PPO C-SNP) plan offers comprehensive coverage featuring no copays for primary care visits, routine annual physicals, and home health services. For hospital stays, members pay a $407 copay for the first several days of inpatient care with no coinsurance, while emergency room visits carry a $115 copay that is waived if admitted within 24 hours. Specialist visits and outpatient services are highly accessible, with specialist copays ranging from $0 to $50 and outpatient hospital services requiring a copay between $0 and $495. This plan also includes key supplemental benefits to reduce out-of-pocket costs, such as no copays for routine vision and hearing exams, alongside a $1,500 annual limit for dental care with no copay and 0% to 50% coinsurance. Additionally, members benefit from a $25 monthly reimbursement for over-the-counter items, no copays for diabetic equipment, and durable medical equipment covered with no copay and 0% to 20% coinsurance. Prescription hearing aids are also covered up to a $500 annual maximum per ear with no copay, ensuring essential wellness needs are met affordably.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Chronic Care (PPO C-SNP) with no coinsurance, requiring a $407 copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $407 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and the plan does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
Aetna Medicare Chronic Care (PPO C-SNP) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $495, observation services require a $407 copay per stay, and outpatient substance abuse sessions carry a $40 copay, with prior authorization required for several of these benefits.
Partial Hospitalization See details
Aetna Medicare Chronic Care (PPO C-SNP) covers partial hospitalization services with a copayment of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Aetna Medicare Chronic Care (PPO C-SNP), featuring a $300 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and no copay for air ambulance services, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Chronic Care (PPO C-SNP) with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency and urgent care are also covered up to a $250,000 maximum with no coinsurance, featuring a $115 copay for emergency or urgent services and a $300 copay for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Chronic Care (PPO C-SNP) include primary care physician and podiatry services with no copay and no coinsurance, while specialists range from a $0 to $50 copay with no coinsurance. Therapy, mental health, and psychiatric services have copays of $35 to $40 with no coinsurance, telehealth features a $0 to $50 copay and 20% coinsurance, and chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic care.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Chronic Care (PPO C-SNP), offering annual physicals, health education, memory fitness, and various screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 and bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Chronic Care (PPO C-SNP) covers hearing services, providing annual routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams have a $50 copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual maximum per ear, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Chronic Care (PPO C-SNP) with no deductibles and no coinsurance, offering routine eye exams and eyewear with no copay. Eye exam copays range from $0 to $50 with a $50 annual maximum, while contact lenses, eyeglasses, and frames are covered up to a combined $100 yearly limit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care (PPO C-SNP), featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for other covered services up to a $1,500 annual limit. However, fluoride treatments, other diagnostic or preventive dental services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under Aetna Medicare Chronic Care (PPO C-SNP) with no copay, though prior authorization and step therapy apply. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs feature a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Chronic Care (PPO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Chronic Care (PPO C-SNP) plan, offering durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance. Prosthetic devices are covered with no copay and 20% coinsurance, while diabetic equipment and shoes feature no copay and no coinsurance, with prior authorization required across these categories.
Diagnostic and Radiological Services See details
Aetna Medicare Chronic Care (PPO C-SNP) covers diagnostic and radiological services under prior authorization, offering lab services with no copay or coinsurance, and diagnostic procedures with a $0 to $20 copay. Radiological services require a $20 copay and coinsurance for X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance plus a copay for therapeutic radiology.
Home Health Services See details
Aetna Medicare Chronic Care (PPO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Aetna Medicare Chronic Care (PPO C-SNP) with no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a $20 copay, while pulmonary rehabilitation is not covered and requires a $15 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (PPO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (PPO C-SNP) provides partial coverage for other services with no copay and no coinsurance for covered benefits, which include a $25 monthly reimbursement for over-the-counter (OTC) items, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture, meal benefits, and dual-eligible SNP highly integrated services are 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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