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Aetna Medicare Assure (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure (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 Assure (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Triad North Carolina Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure (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 Assure (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 Assure (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 Assure (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.20. 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 $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 Assure (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. Once the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $42.20. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1885 copay per admission, while emergency services have a $110 copay, and urgently needed services have a $45 copay. Many services, such as outpatient services, partial hospitalization, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, and skilled nursing facility services, are covered with coinsurance and/or copays. This plan also provides coverage for ambulance and transportation services, with varying copays and coinsurance. The plan includes coverage for hearing aids up to $2,000 per year, and offers no copay for many dental services. Additionally, the plan includes coverage for other services, such as over-the-counter items, with a monthly allowance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization, with a copay of $1885 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and outpatient substance abuse services are covered with a minimum 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Assure (HMO D-SNP), but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Assure (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year via rideshare, bus/subway, or medical transport, but 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. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, both with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Under the Aetna Medicare Assure (HMO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance, while mental health, psychiatric, and opioid treatment program services have a 20% coinsurance for individual and group sessions. Podiatry services have a 20% coinsurance and no copay for Medicare-covered services, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $45. Routine chiropractic care is not covered.
Preventive Services See details
Aetna Medicare Assure (HMO D-SNP) covers preventive services including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, all of which may have a copay.
Hearing Services See details
Hearing services are covered, including hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluations for hearing aids have no copay and a coinsurance of at most 20%, while prescription hearing aids (all types) have no copay and are covered up to $2,000 per year. Prescription hearing aids are not covered for inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and routine eye exams with no copay. Eyewear is covered with a 20% coinsurance, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services, and a $2,500 maximum plan benefit per year for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan. A prior authorization is required, and you will pay 20% coinsurance.
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 no copay; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan, with no copay. For Diagnostic Procedures/Tests and Lab Services, you pay at most 20% coinsurance. For Diagnostic Radiological Services, you pay no coinsurance, while for Therapeutic Radiological Services and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure (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 covered by the Aetna Medicare Assure (HMO D-SNP) plan, but the plan does not cover the sub-services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Assure (HMO D-SNP) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, Meal Benefit, annual wellness exam, screening mammography, and gFOBT/FIT, among others. Over-the-Counter (OTC) Items have no copay, and a maximum benefit of $205.00 every month, while acupuncture and several other services are not covered.
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