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Aetna Medicare Dual Preferred (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Preferred (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 Preferred (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern Alabama Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Preferred (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 Preferred (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 Preferred (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 Preferred (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.20. 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 Dual Preferred (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your prescriptions, but the specific costs for each tier of drugs are not provided in this summary. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase. If you qualify for the low-income subsidy (LIS), the monthly premium for Part D drugs is $9.20.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan provides extensive coverage, including inpatient and outpatient hospital services, with varying copays and coinsurance amounts. Emergency, urgent, and worldwide emergency services are covered with copays, while many primary care, preventive, and vision services have no copay. Dental services are included with a 20% coinsurance up to $2,500 per year. Additional benefits include hearing exams and hearing aids, ambulance services, home health services, and medical equipment. The plan also offers coverage for home infusion, dialysis, and skilled nursing facility services. Other notable benefits include over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric stays, the copay is $1980 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, including outpatient hospital services with a 0% - 20% coinsurance, observation services with a 20% coinsurance, and ambulatory surgical center (ASC) services with a 0% - 20% coinsurance. Additionally, outpatient substance abuse services are covered, with a 20% coinsurance for both individual and group sessions, as well as outpatient blood services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a Plan Approved Health-related Location are covered with no copay, and up to 48 one-way trips per year are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers primary care, chiropractic services, occupational therapy, 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, and Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance; Other Health Care Professional Services have a coinsurance between 0% and 20%; Routine Chiropractic Care has no copay, but all other Chiropractic Services have a 20% coinsurance; and Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar services and an annual physical exam with no copay. Additional preventive services are covered, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, with a copay for some services. 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.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids have no copay for all types, and a maximum benefit of $500 per ear every year.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers dental services with a 20% coinsurance, up to a maximum of $2,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while medical supplies have a 20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance. Diabetic supplies have no coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. There is no copay for diagnostic services, with a coinsurance of up to 20%, and no copay for radiological services, with a coinsurance of up to 20%, though the minimum coinsurance varies.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Preferred (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 Dual Preferred (HMO D-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan follows original Medicare for SNF services and does not cover additional days beyond Medicare or non-Medicare-covered stays.
Other Services See details
Other Services include coverage for over-the-counter items with no copay, a maximum benefit of $155 per month, and meal benefits with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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