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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 Metro St Louis - Illinois. This plan received an overall rating of 4 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 $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 $6750.00 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:
Sign up for Aetna Medicare Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. For Tier 2 generic drugs, copays start as low as $5 for a one-month supply at preferred locations, while standard pharmacies charge a $12 copay. For higher-tier prescriptions, the plan utilizes coinsurance percentages rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates remain consistent whether you fill your prescription at a preferred or standard pharmacy, or through mail order.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) offers comprehensive healthcare coverage with no copays for primary care visits, routine hearing and vision exams, home health services, and preventive dental care. Specialist visits and diagnostic services feature low copays ranging from $0 to $25, while inpatient hospital stays require daily copays for the first six days before transitioning to no copay. Emergency care is accessible with a $130 copay that is waived upon hospital admission, and urgently needed services carry a $50 copay. This plan also features valuable extras, including a $30 monthly over-the-counter allowance, a $150 annual eyewear allowance, and up to $500 per ear annually for prescription hearing aids with no copay. Comprehensive dental care is covered with no copay and a 20% to 50% coinsurance up to a $1,250 annual limit. Additionally, medical equipment and supplies are covered with no copays and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $410 daily copay for days 1 to 6 and no copay for days 7 to 90, while psychiatric stays require a $375 daily copay for days 1 to 6 and no copay for days 7 to 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Patients will pay a $0 to $375 copay for outpatient hospital services, a $375 copay per stay for observation services, and a $25 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Aetna Medicare Chronic Care (HMO C-SNP) covers partial hospitalization with a copayment of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. For transportation services, some services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care physician services and routine podiatry with no copay and no coinsurance, while specialist visits range from a $0 to $25 copay with no coinsurance. Physical, occupational, speech, and mental health therapies require a $25 copay and no coinsurance, though chiropractic services are only partially covered as routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), offering no copay and no coinsurance for annual physicals, diabetes training, and fitness benefits, while kidney disease education has no copay and a 20% coinsurance. Multiple sub-services are not covered under this plan, including in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no deductible, requiring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fittings. Prescription hearing aids are covered with no copay or coinsurance up to $500 per ear annually, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers routine and follow-up diabetic eye exams, as well as eyewear, with no copay or coinsurance, including up to a $150 annual maximum for eyewear. Medicare-covered eye exams are also covered with a $25 copay and no coinsurance.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental, alongside preventive care with no copay and no coinsurance. Comprehensive care is covered with no copay and 20% to 50% coinsurance up to a $1,250 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services 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 require prior authorization. Under this plan, Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Chronic Care (HMO C-SNP) with no copays for all categories, subject to prior authorization. Coinsurance ranges from no coinsurance to 20% for durable medical equipment (DME) and medical supplies, is 20% for prosthetics, and features no coinsurance for diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $25 copay for procedures, while radiological services carry a $25 copay for X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Aetna Medicare Chronic Care (HMO C-SNP) are covered with no copay and no coinsurance, although in practice, sub-services such as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides partially covered other services with no copay and no coinsurance for covered benefits, which include a $30 monthly over-the-counter (OTC) allowance, annual wellness exams, and additional colorectal cancer screenings. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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