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Aetna Medicare Assure Flex (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Flex (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 Flex (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Flex (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 2025.
It's important to know that Aetna Medicare Assure Flex (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 Flex (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 Flex (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 Flex (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. 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 $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 Flex (HMO D-SNP) plan has a deductible of $590. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use. You will enter the next coverage phase once your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify, you will pay $20.30 per month.
Additional Benefits
The Aetna Medicare Assure Flex (HMO D-SNP) plan offers a range of benefits. Inpatient hospital stays have a $1670 copay per admission, while emergency services have a $110 copay and urgently needed services have a $45 copay. Many services, including outpatient services, primary care, and preventive services, have either no copay or a 20% coinsurance. This plan provides coverage for hearing, vision, and dental services. Hearing exams have a 20% coinsurance, while prescription hearing aids are covered up to $1250 per year. Eye exams have a 20% coinsurance, and eyewear is covered up to $100 per year. Dental services like oral exams, X-rays, and cleanings have no copay. The plan also includes coverage for home health services, medical equipment, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $1670 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 are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Assure Flex (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while 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. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure Flex (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Most services require a 20% coinsurance, while additional telehealth benefits have a copay between $0 and $45. Routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Assure Flex (HMO D-SNP) plan 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 with no copay. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a 20% coinsurance for routine hearing exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to a maximum of $1250 per year, with no copay for all types of hearing aids except for inner ear, outer ear, and over the ear hearing aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Assure Flex (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance for routine eye exams, and other eye exam services and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage amount of $100 per year, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
The Aetna Medicare Assure Flex (HMO D-SNP) plan covers certain dental services, including oral exams, dental x-rays, and cleanings with no copay. Medicare dental services have a 20% coinsurance, and fluoride treatments, orthodontics, and other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Assure Flex (HMO D-SNP) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan. All diagnostic services have no copay and are subject to coinsurance, and diagnostic procedures/tests and lab services have a coinsurance of at most 20%. Radiological services have no copay and are subject to coinsurance, with a coinsurance of at most 20% for diagnostic and therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Flex (HMO D-SNP) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Assure Flex (HMO D-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Assure Flex (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. This plan offers a maximum of $275 per month for OTC items.
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