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Aetna Medicare Full Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full 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 Full Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Upstate. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full 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 Full 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 Full 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 Full Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.30. 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 Full Dual (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This zero-dollar cost sharing applies to one-month, two-month, and three-month supplies. For higher-tier medications, the plan requires coinsurance instead of set copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply to prescription fills at standard retail pharmacies as well as standard mail-order services.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) offers comprehensive medical coverage, featuring no copays for primary, specialist, and outpatient services, though a standard 20% coinsurance typically applies. Inpatient hospital stays require a $1,860 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Diagnostic services, dialysis, and durable medical equipment also feature no copays alongside a 20% coinsurance. This plan also provides robust supplemental benefits, including dental and vision care with no copays and generous annual allowances, such as up to $2,000 for dental services and $2,000 per ear for hearing aids. Vision exams and eyeglasses are covered with no copays, and members receive a $125 monthly allowance for over-the-counter items with no cost-sharing. Preventive care and home health services are fully covered with no copays or coinsurance, helping you manage your health affordably.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a copayment of $1,860 per stay and no coinsurance, subject to prior authorization. While unlimited additional days for acute care are covered with no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Full Dual (HMO D-SNP) with prior authorization required. Covered services cost either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. For transportation, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a maximum plan benefit limit of $250,000.
Primary Care See details
Aetna Medicare Full Dual (HMO D-SNP) primary care benefits cover primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance. Chiropractic services are partially covered, as routine and other chiropractic care are not covered, while telehealth benefits carry a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), with annual physicals, fitness benefits, and health education requiring no copay and no coinsurance, while kidney disease education and select screenings require no copay and a 20% coinsurance. Uncovered services under this benefit include in-home safety assessments, medical nutrition therapy, 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, counseling, post-discharge medication reconciliation, and re-admission prevention.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), featuring routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $2,000 per ear annually with no copay or coinsurance, while 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 Full Dual (HMO D-SNP) with no deductibles, featuring routine eye exams and contact lenses with no copays and 20% coinsurance. Eyeglasses, upgrades, and follow-up diabetic eye exams are also covered with no copays and no coinsurance, up to a $200 annual maximum for eyewear.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) up to a $2,000 annual maximum, offering no copay and no coinsurance for most covered preventive and comprehensive services. Medicare-covered dental services require no copay and a 20% coinsurance, but orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual (HMO D-SNP) covers durable medical equipment, prosthetics, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Full Dual (HMO D-SNP) with prior authorization and no copays. Covered diagnostic procedures, lab services, therapeutic radiology, 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 Full Dual (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Aetna Medicare Full Dual (HMO D-SNP) with no copay, though only some services are covered. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (HMO D-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance, including a $125 monthly over-the-counter allowance, chronic illness meal benefits, and select wellness screenings. Acupuncture is not covered under this benefit.
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