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Aetna Medicare Dual Extra Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra 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 Dual Extra Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select LA Parishes. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra 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 Dual Extra 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 Dual Extra 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 Dual Extra Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.90. 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 Dual Extra Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail order costs are a $10 copay for a one-month supply, a $20 copay for a two-month supply, and a $30 copay for a three-month supply. Higher-tier medications are covered with coinsurance at standard pharmacies and through standard mail order. You will pay a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance, which is available only for a one-month supply.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) offers comprehensive medical coverage with varying out-of-pocket costs depending on the service. For inpatient hospital stays, members pay a $1,775 copay per admission with no coinsurance, while primary care, specialist visits, and outpatient services generally feature no copay and a 20% coinsurance. Emergency care requires a $115 copay, which is waived if admitted, and urgent care has a $40 copay. This plan also includes valuable supplemental benefits like dental, vision, and hearing coverage, often with no deductible and no copays. Routine dental and vision care, along with hearing aids up to $750 per ear, are covered with no copay and low or no coinsurance. Additionally, members can benefit from home health services, up to 24 one-way transportation trips, and a $157 monthly allowance for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers inpatient hospital and psychiatric stays with a $1775 copayment per admission and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, 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
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization services with prior authorization, costing either a 20% coinsurance with no copay or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, with no coinsurance required for either service. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a maximum benefit limit of $250,000.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care, specialist, and mental health services with no copay and 20% coinsurance, while telehealth benefits are available with no copay and no coinsurance. Chiropractic benefits are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Dual Extra 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 other screenings require no copay but have a 20% coinsurance. Not covered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, featuring routine hearing exams with a 20% coinsurance and no copay, alongside fittings and evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $750 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 Dual Extra Care (HMO D-SNP) covers vision services with no deductible, offering Medicare-covered exams, follow-up diabetic eye exams, and eyeglasses with no copays. Routine eye exams (one per year) and contact lenses are covered with no copay and a 20% coinsurance, with a combined eyewear maximum benefit of $275 per year.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $3,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copays, though prior authorization is required. Under this plan, diabetic supplies have no coinsurance, while durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copays, though prior authorization is required for all services. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Extra Care (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra 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, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance, featuring a chronic illness meal benefit, wellness exams, and a monthly $157 allowance for over-the-counter items. Acupuncture is not covered under this plan.
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