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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 AL - Statewide. 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 Enhanced Alternative drug benefit with a prescription drug deductible of $615.00. During the initial coverage phase, which lasts until total drug costs reach $2,100.00, you will pay a $10.00 copay for Tier 1 preferred generic drugs at standard pharmacies and standard mail. For Tier 2 standard generics, there is a 22% coinsurance, while Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance. If you qualify for the Low-Income Subsidy, also known as Extra Help, your Part D cost is reduced to no cost. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescription drugs.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) plan offers comprehensive medical coverage with no copays for primary care, specialist visits, outpatient hospital services, and home health care, though a 20% coinsurance applies to many doctor and outpatient services. Inpatient hospital stays require a $1,910 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. For skilled nursing facilities, members pay no copay or coinsurance for the first 20 days, followed by a $218 daily copay for days 21 through 100. This plan also features valuable supplemental benefits, including no copays or coinsurance for routine dental care up to a $1,500 annual limit and select preventive services. Additionally, members benefit from no copays on routine vision and hearing exams, a $300 annual eyewear allowance, up to $1,500 per ear for hearing aids, and up to 24 free one-way transportation trips per year. A monthly allowance of up to $120 is also provided for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers inpatient hospital services, requiring a $1,910 copay per stay and no coinsurance for both acute and psychiatric admissions. Unlimited additional days for acute stays are included with no copay, but upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered under Aetna Medicare Dual Extra Care (HMO D-SNP) with no copays for all covered care. Members will pay no coinsurance to 20% coinsurance for outpatient hospital and ambulatory surgical center services, and 20% coinsurance for outpatient blood, observation, and substance abuse services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan, with prior authorization required. Members are responsible for cost sharing that includes a $110 copay or a 20% 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, though prior authorization is required. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are 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 up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care, specialist, and various therapy services with a 20% coinsurance and no copay. Telehealth, routine chiropractic, and podiatry services are also covered with no copay and coinsurance ranging from none to 20%.
Preventive Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers preventive services, offering no copay for annual physical exams and select supplemental benefits, while requiring a 20% coinsurance for kidney disease education, glaucoma screenings, and diabetes training. Specific sub-services are not covered, including weight management, therapeutic massage, in-home safety assessments, and nutritional counseling.
Hearing Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers hearing exams, including one annual routine exam with no copay and 20% coinsurance, and one fitting evaluation with no copay and no coinsurance. Prescription hearing aids are partially covered up to $1,500 per ear annually with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers vision services with no deductibles, offering routine and diabetic eye exams with no copays, though routine exams carry a 20% coinsurance. Eyewear is covered up to $300 annually with no copays, featuring no coinsurance for eyeglasses and frames, while contact lenses require a 20% coinsurance.
Dental Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers dental services, offering covered preventive and comprehensive services with no copay and no coinsurance up to a $1,500 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a 20% coinsurance and no copay.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers Home Infusion bundled Services with prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Dual Extra Care (HMO D-SNP) plan with no copays and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay and no coinsurance, though prior authorization is required for these equipment benefits.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers diagnostic and radiological services with no copay and coinsurance ranging from no coinsurance up to 20% depending on the specific service. Prior authorization is required for these covered benefits, which include lab tests, diagnostic procedures, therapeutic radiology, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Dual Extra Care (HMO D-SNP), meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), as additional days beyond Medicare-covered stays are not covered. Covered stays require prior authorization and feature no copay and no coinsurance for days 1 through 20, followed by a $218 daily copay and no coinsurance for days 21 through 100.
Other Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers other services with no copay and no coinsurance for covered options like meal benefits, select wellness screenings, and up to $120 monthly for over-the-counter items. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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