A non-government entity
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 Michigan. This plan received an overall rating of 3 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 $8.80. 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Full Dual Care (HMO D-SNP) plan has an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supplies of these generic drugs. For higher-tier medications, your costs are determined by coinsurance percentages at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply to one-month, two-month, and three-month supplies, with the exception of Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
Aetna Medicare Full Dual Care (HMO D-SNP) offers comprehensive healthcare coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies. Inpatient hospital stays require a $1,780 copayment per stay with no coinsurance, while skilled nursing facility care features no copay for the first 20 days and a $218 copay for days 21 through 100. Emergency care is available with a $115 copay, which is waived upon hospital admission, and urgent care requires a $40 copay. The plan also features robust supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance up to a $2,500 annual limit. Additionally, beneficiaries receive a $200 monthly over-the-counter item reimbursement, along with routine vision and hearing exams that require no copays. Prescription hearing aids are covered up to $1,250 per ear annually with no copay, and home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,780 copayment per stay, no coinsurance, and required 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 with no copay, but a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these outpatient services, though there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services with prior authorization, requiring either a 20% coinsurance with no copay or 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, subject to prior authorization. Transportation services to health-related locations are not covered under this plan.
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 you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $250,000 maximum benefit with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered. Telehealth benefits are also available with a copay of $0 to $40 and 20% coinsurance.
Preventive Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers preventive services, offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and glaucoma screenings require no copay and a 20% coinsurance. Sub-services not covered under this plan include medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, and counseling services.
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 annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no deductibles, offering annual routine eye exams and follow-up diabetic eye exams with no copay, though routine exams require a 20% coinsurance. Covered eyewear—including eyeglasses, frames, lenses, and contact lenses—has no copay, with a 20% coinsurance applying to contact lenses, up to a $250 combined annual maximum.
Dental Services See details
Dental services are covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring Medicare-covered dental care with no copay and a 20% coinsurance, and preventive and comprehensive dental services with no copay and no coinsurance up to a $2,500 annual limit. This benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics 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 is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts have a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. There is a 20% coinsurance for lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services carry no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, including a $200 monthly over-the-counter item reimbursement, meals for chronic illness, annual wellness exams, and additional colorectal cancer screenings. Acupuncture and highly integrated dual-eligible services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved