A non-government entity
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 - Missouri. 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan has 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, while standard options require a small copay starting at $2. Tier 2 generic drug copays start at $5 at preferred locations and $12 at standard locations for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply equally across preferred and standard pharmacies as well as mail-order services.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low copay of up to $25, while inpatient hospital stays feature daily copays for the first six days before transitioning to no copay for longer stays. Emergency room visits carry a $130 copay, which is waived if you are admitted, alongside a $50 copay for urgent care. This plan also includes valuable supplemental benefits like routine dental, vision, and hearing exams with no copays. Comprehensive dental services are covered with a 20% to 50% coinsurance up to a $1,500 annual limit, while eyewear and hearing aids feature annual allowances of $125 and $500 per ear, respectively. Additionally, members can take advantage of a $50 monthly allowance for over-the-counter health items with no copay.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization. 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. This benefit is partially covered, as additional days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $375 copay and observation services with a $375 copay per stay. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse services carry a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with a copay of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Chronic Care (HMO C-SNP), offering ground ambulance services for a $300 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay, both requiring prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgent care with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum benefit with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care and routine podiatry services with no copay and no coinsurance, while physical therapy, specialists, and mental health services require copays up to $25 with no coinsurance. Telehealth services are also available with a copay of $0 to $50 and 20% coinsurance, though chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers annual physical exams, select screenings, and fitness benefits with no copay and no coinsurance, while kidney disease education is covered with no copay and a 20% coinsurance. Other preventive services are partially covered, excluding 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 benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though inner-ear, outer-ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Medicare-covered eye exams with a $25 copay and no coinsurance, while routine and follow-up diabetic eye exams have no copay or coinsurance, with no deductible. Covered eyewear, including lenses, frames, and contacts, also features no copay or coinsurance up to a combined maximum benefit of $125 per year.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides partially covered dental services, which include Medicare-covered dental for a $25 copay and no coinsurance, alongside preventive cleanings and exams for no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $1,500 annual limit, but fluoride treatments, implant services, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay with no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copays for all items, including durable medical equipment (DME), prosthetics, and diabetic supplies. DME and medical supplies have a coinsurance of 0% to 20%, prosthetic devices require a 20% coinsurance, and diabetic equipment features no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers diagnostic and radiological services, featuring no copay or coinsurance for lab services and a $0 to $25 copay with no coinsurance for diagnostic tests. Diagnostic radiology offers copays starting at $0 with no coinsurance, while outpatient x-rays require a $25 copay and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) 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, a three-day prior hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services, offering covered benefits such as annual wellness exams, screening mammographies, additional gFOBT and FIT tests, and up to $50 monthly in over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved