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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 South 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 $9.30. 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:
Sign up for Aetna Medicare Full Dual Care (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Full Dual Care (HMO D-SNP) plan has an annual drug deductible of $615. This plan offers no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. For higher-tier medications, costs are based on a percentage of the drug cost rather than a flat copayment. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers comprehensive medical coverage with no copay and 20% coinsurance for outpatient services, primary care, and specialist visits. Inpatient hospital stays require a $1,735 copayment per admission, while emergency room visits carry a $115 copay that is waived if you are admitted. Home health services are covered with no copay or coinsurance, and skilled nursing facility stays feature no copay for the first 20 days. For supplemental care, the plan provides preventive dental services, annual physicals, and hearing aid fittings with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually, and routine eye exams are available with no copay and 20% coinsurance. Additionally, members benefit from a $200 monthly over-the-counter item reimbursement to help manage health expenses.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,735.00 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, 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, substance abuse, and blood services, with no copays 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
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service setup, you will pay either a 20% coinsurance with no copay, or a $110.00 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, trips to plan-approved locations and any health-related locations are 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. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Primary Care services under Aetna Medicare Full Dual Care (HMO D-SNP) are generally covered with no copay and 20% coinsurance, including PCP, specialist, psychiatric, and physical therapy visits. Chiropractic services are partially covered, as routine chiropractic care and other chiropractic services are not covered, while telehealth benefits require a 20% coinsurance and a copay ranging from $0 to $40.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering no copay and no coinsurance for annual physical exams and select supplemental benefits, while kidney disease education and specific screenings require no copay and a 20% coinsurance. However, sub-services including in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, caregiver support, enhanced disease management, telemonitoring, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering routine exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductibles, including one annual routine eye exam with no copay and 20% coinsurance. Eyewear is covered with no copays and no coinsurance—except for contact lenses, which carry a 20% coinsurance—up to a combined maximum plan benefit of $100 per year.
Dental Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers partial coverage for dental services, with Medicare-covered dental requiring no copay and a 20% coinsurance. Preventive services like oral exams, cleanings, and x-rays are covered with no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, prosthodontic, implant, and orthodontic 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, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance between 0% and 20%.
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. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry 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 Full Dual Care (HMO D-SNP) with prior authorization and no copays. There is a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services require 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
Aetna Medicare Full Dual Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, although some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a $200 monthly over-the-counter item reimbursement, meals for chronic illness, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and Other 3 services are not covered.
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