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Aetna Medicare Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in North Carolina Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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 Dual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for up to a three-month supply filled at standard pharmacies or through standard mail order. This ensures that essential generic medications remain highly accessible and affordable. For brand-name and specialty medications, coverage costs are based on coinsurance rather than set copays. You will pay a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply through standard pharmacy or mail-order channels.
Additional Benefits
The Aetna Medicare Dual (HMO D-SNP) plan covers essential medical services, often requiring no copays but subject to a standard 20% coinsurance for outpatient care, doctor visits, and diagnostic services. Inpatient hospital stays require a $1,920 copay per stay with no coinsurance, while emergency care carries a $115 copay that is waived if you are admitted. Skilled nursing facility stays feature no copay for the first 20 days, followed by a daily copay of $218. This plan also provides valuable supplemental benefits, including dental care and prescription hearing aids with no copay or coinsurance up to a $2,000 annual limit. Vision services feature routine exams with no copay and a 20% coinsurance, alongside eyewear covered with no copay or coinsurance up to a $125 yearly limit. Additionally, members benefit from home health services with no copay or coinsurance, as well as a $205 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Dual (HMO D-SNP) with a $1,920 copay per stay, no coinsurance, and prior authorization required. The benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute days are provided with no copay.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Dual (HMO D-SNP) with no copays, though a 20% coinsurance and prior authorization are required for outpatient hospital, observation, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services also have no copay and a 20% coinsurance, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Dual (HMO D-SNP) covers partial hospitalization services, which require 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
Aetna Medicare Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 6 one-way trips per year to plan-approved health-related locations, though trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Dual (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Dual (HMO D-SNP) provides primary care benefits with no copay and a 20% coinsurance for primary care, specialist, physical therapy, psychiatric, and opioid treatment services. While some chiropractic services are covered, routine and other chiropractic services are not covered, and telehealth services are available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual (HMO D-SNP), offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and other screenings have no copay but a 20% coinsurance. Uncovered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, 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, and counseling.
Hearing Services See details
Aetna Medicare Dual (HMO D-SNP) partially covers hearing services, featuring routine hearing exams with no copay and 20% coinsurance, and fitting evaluations and prescription hearing aids with no copay and no coinsurance up to $2,000 per ear yearly. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Dual (HMO D-SNP) covers vision services with no deductible, offering routine eye exams and contact lenses with no copay and a 20% coinsurance. Other covered eye exams and eyewear, such as eyeglasses and frames, feature no copay and no coinsurance, subject to a $125 annual combined maximum benefit.
Dental Services See details
Aetna Medicare Dual (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance up to a $2,000 annual limit, though Medicare-covered dental services require a 20% coinsurance and no copay. While most preventive and comprehensive services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual (HMO D-SNP) with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with prior authorization required and no copays. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Dual (HMO D-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered in practice. These services require a 20% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Dual (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services offered by Aetna Medicare Dual (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for a $205 monthly over-the-counter item allowance, chronic illness meals, and annual wellness screenings. However, acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
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