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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 Southern 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 $20.60. 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 drugs based on the drug tier and pharmacy you use. Once your total drug costs reach $2000, you enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $20.60 for your Part D premium. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1650 copay per admission, while outpatient services and partial hospitalization have coinsurance requirements. Emergency and urgently needed services have copays, and ambulance services have a 20% coinsurance. Preventive services and many other services like dental and vision have no copay, while others have coinsurance, and hearing aids are covered up to $500 per year, per ear. The plan includes coverage for home health services with no copay, OTC items up to $140 per month, and other services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. The copay for a Medicare-covered stay is $1650 per admission or stay, while Additional Days for Inpatient Hospital-Acute has no copay, and Non-Medicare-covered Stay and Upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a coinsurance of 0% - 20%, observation services have a 20% coinsurance, individual and group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under 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 by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services have no copay. Transportation Services to any health-related location are limited to 36 one-way trips per year, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan with a $110 copay. Urgently Needed Services have a $45 copay, and Worldwide Emergency Services are covered with no copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers Primary Care Physician Services with a 10% coinsurance, Chiropractic Services with a 20% coinsurance (routine care), Occupational Therapy Services with a 20% coinsurance, and Physician Specialist Services with a 20% coinsurance. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance.
Preventive Services See details
Preventive Services include no copay for annual physical exams, additional preventive services have a copay that varies depending on the service, and no coinsurance for any service. Services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% and a copay for Medicare-covered benefits, as well as fitting/evaluation for hearing aids with no copay. Prescription hearing aids have a maximum benefit of $500 per year, per ear, with no copay for all types of prescription hearing aids.
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 with a combined maximum plan benefit of $400 per year, and eyeglasses, frames, lenses, contact lenses, and upgrades have no copay.
Dental Services See details
Dental Services are covered, with a $3,000 maximum benefit 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, but other services have visit limits or other restrictions. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 Dual Preferred (HMO D-SNP) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan, with no copay for any services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%, and Therapeutic Radiological Services have a 20% coinsurance.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. The plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare-covered stays are not covered. You must get prior authorization for SNF services and you will be responsible for the Medicare-defined cost share for tier 1.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $140 per month. The plan also covers meal benefits and other services like annual wellness exams, screening mammography, gFOBT, and FIT with no copay. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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