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Aetna Medicare Assure Premier (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Premier (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 Premier (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Premier (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Premier (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 Premier (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 Premier (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 Premier (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.30. 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 Premier (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the drug tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you may be eligible for a reduced monthly premium.
Additional Benefits
The Aetna Medicare Assure Premier (HMO D-SNP) plan offers comprehensive coverage with a focus on outpatient services, primary care, and preventative care. This plan includes no copay for many services such as preventive services, hearing exams, routine eye exams, and dental cleanings. You will also pay a copay for emergency services, and other services will have a coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but there is a $2,000 copay per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including 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, and substance abuse services have a minimum of 20% and a maximum of 20% coinsurance.
Partial Hospitalization See details
Aetna Medicare Assure Premier (HMO D-SNP) covers partial hospitalization with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance Services are covered with no copay and a 20% coinsurance for both ground and air ambulance services; however, Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the Aetna Medicare Assure Premier (HMO D-SNP) plan. You will pay a $110 copay for emergency services, and a $45 copay for urgently needed services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure Premier (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. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance, while chiropractic services and routine chiropractic care have a 20% coinsurance. Routine chiropractic care has no copay, while other chiropractic services have a copay. Individual and group sessions for mental health and psychiatric services have a 20% coinsurance. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a 20% coinsurance, and podiatry services have a 20% coinsurance and copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services, such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, are covered with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a 20% coinsurance for routine exams, and no copay for Medicare-covered benefits, and fitting/evaluation for hearing aids, and prescription hearing aids (all types) have no copay. Prescription hearing aids have a maximum plan benefit coverage of $1500.00 per year.
Vision Services See details
The Aetna Medicare Assure Premier (HMO D-SNP) plan covers vision services including eye exams and eyewear. Routine eye exams have no copay, and other eye exam services have no copay. Eyewear has a 20% coinsurance for some services, and a combined maximum plan benefit of $310 per year, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Assure Premier (HMO D-SNP) plan covers Medicare and other dental services, with a $2,600 maximum benefit per year. Oral exams, dental X-rays, other diagnostic services, cleaning, fluoride treatment, and other preventive services have no copay, while Medicare dental services have a 20% coinsurance. Restorative, endodontics, periodontics, prosthodontics (removable and fixed), and oral surgery services have no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 by the Aetna Medicare Assure Premier (HMO D-SNP) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. Diagnostic Procedures/Tests, and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%, and Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Assure Premier (HMO D-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Premier (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF, and it does not cover non-Medicare-covered stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Aetna Medicare Assure Premier (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Other services such as Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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