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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Upstate South Carolina. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members benefit from no copay when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs are available with a low $5 copay for a one-month supply at preferred locations, compared to a $12 copay at standard pharmacies. Higher-tier medications require coinsurance rather than set copays, with Tier 3 preferred brand drugs carrying a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for a one-month supply. Understanding these copay and coinsurance levels helps Medicare beneficiaries estimate their annual out-of-pocket prescription costs.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, annual physicals, and home health services. For specialized care, beneficiaries can expect a $0 to $35 copay for specialist visits and no copay for routine eye exams, while inpatient hospital stays require a daily copay of $388 for the first seven days of an acute stay. Emergency care is covered with a $115 copay, which is waived if you are admitted, and urgently needed services carry a $40 copay. This plan also includes valuable everyday health benefits, featuring no copay for routine dental cleanings, annual hearing exams, and diagnostic lab tests. Additionally, members receive a $100 annual eyewear allowance, up to $500 per ear annually for prescription hearing aids, and a $50 monthly reimbursement for over-the-counter items. Durable medical equipment and dialysis services are covered with no copay and coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $388 daily copay for days 1 to 7 of an acute stay and a $260 daily copay for days 1 to 8 of a psychiatric stay, with no copay for subsequent days up to day 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance across all categories, including ambulatory surgical center and blood services which also feature no copay. Outpatient hospital services have a copay ranging from $0 to $388, observation services require a $388 copay per stay, and individual or group outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Aetna Medicare Chronic Care (HMO C-SNP) covers partial hospitalization services with a copayment of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Aetna Medicare Chronic Care (HMO C-SNP) plan cover ground ambulance services with a $285 copay and air ambulance services with a 20% coinsurance, both of which require prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $285.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) provides primary care and podiatry visits with no copay and no coinsurance, while specialists and therapy services require a $0 to $35 copay and no coinsurance. Mental health and opioid treatments have a $25 copay and no coinsurance, telehealth carries a $0 to $35 copay and 20% coinsurance, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers annual physical exams, zero-dollar preventive services, and screenings with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Additional preventive services are partially covered, offering health education and memory fitness benefits with no copay and no coinsurance, while excluding services like in-home safety assessments and nutritional benefits.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers hearing services with a $35 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers eye exams with a $0 to $35 copay and no coinsurance, which includes one routine exam per year with no copay. Eyewear is also covered with no copay and no coinsurance up to a combined maximum of $100 annually for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring Medicare-covered dental care for a $35.00 copay and no coinsurance. Covered preventive services, including up to four oral exams, two cleanings, and one dental X-ray annually, are provided with no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required and features no copay across all categories. Durable medical equipment and medical supplies carry 0% to 20% coinsurance, prosthetic devices require 20% coinsurance, and diabetic supplies and therapeutic shoes are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan, with prior authorization required for all services. Diagnostic services feature no coinsurance, offering lab tests with no copay and other diagnostic procedures with a $0 to $200 copay, while radiological services include outpatient X-rays with no copay and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and 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 Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered other services with no copay and no coinsurance for covered benefits, which include annual wellness exams, screening mammographies, additional gFOBT and FIT, and a $50 monthly over-the-counter item reimbursement. Acupuncture, meal benefits, and Dual Eligible SNP highly integrated services are not covered under this plan.
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