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Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual Care (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 Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (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 Metro Areas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual Care (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 Care (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 Care (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 Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. 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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This coverage applies to one-month, two-month, and three-month supplies. For higher-tier medications, your costs are determined by coinsurance rates rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance for standard pharmacy and standard mail order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers comprehensive coverage where many routine services, including primary care, outpatient care, and specialist visits, require no copay and a 20% coinsurance. For major medical events, inpatient hospital stays require a $1,870 copay per stay, while emergency room visits carry a $115 copay that is waived upon admission. Essential services like preventive care, home health, and routine dental cleanings are fully covered with no copay and no coinsurance. Additionally, this plan features valuable supplemental benefits to help manage your everyday health and wellness costs. Members receive a $285 monthly allowance for over-the-counter items, as well as up to $1,250 per ear annually for prescription hearing aids with no copay or coinsurance. Vision benefits also include no copay for eyeglasses and frames, while diabetic supplies are covered with no coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers inpatient hospital services with a $1,870 copay per stay and no coinsurance for both acute and psychiatric admissions, which require prior authorization. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and a 20% coinsurance. 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 under the Aetna Medicare Full Dual Care (HMO D-SNP) plan and requires prior authorization, with member costs ranging from a 20% coinsurance with no copay to a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Full Dual Care (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 up to a $250,000 maximum benefit with no copays or coinsurance.
Primary Care See details
Primary care services under Aetna Medicare Full Dual Care (HMO D-SNP) are covered with no copay and a 20% coinsurance for most doctor, specialist, psychiatric, and therapy visits. Telehealth services carry a $0 to $40 copay and 20% coinsurance, while chiropractic care is only partially covered, with routine and other chiropractic services not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring an annual physical exam and select supplemental benefits with no copay and no coinsurance. Other covered benefits like kidney disease education and glaucoma screenings require a 20% coinsurance and no copay, while services like nutritional benefits, alternative therapies, and in-home support are not covered.
Hearing Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers hearing services with no deductible, offering routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear yearly with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no deductible, featuring one routine eye exam per year with no copay and a 20% coinsurance, plus follow-up diabetic eye exams with no copay. Covered eyewear is subject to a $100 annual maximum, offering contact lenses with a 20% coinsurance and no copay, and eyeglasses, lenses, frames, and upgrades with no copay.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental services. Covered preventive care includes up to four oral exams, two cleanings, and one X-ray per year with no copay and no coinsurance, though fluoride, restorative, endodontic, periodontic, prosthodontic, orthodontic, and oral surgery services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual Care (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 Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. A 20% coinsurance applies to lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Full Dual Care (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 under the plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no coinsurance, requiring prior authorization but no 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 standard Medicare-covered period are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) provides covered other services with no copay and no coinsurance, including a monthly $285 over-the-counter (OTC) item allowance, chronic illness meal benefits, annual wellness exams, and additional colorectal screenings. However, acupuncture is not covered under this plan.
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