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Aetna Medicare Dual Extra (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across MS. 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 (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 (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 (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 (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:
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Drug Coverage
The Aetna Medicare Dual Extra (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are covered with no copay for one-month, two-month, and three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, Tier 3 preferred brand drugs require a 22% coinsurance for one-month, two-month, and three-month supplies through standard pharmacies and standard mail order. Tier 4 non-preferred drugs carry a 25% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. These cost-sharing rates apply to both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Aetna Medicare Dual Extra (HMO D-SNP) offers robust coverage for core medical needs, often featuring no copays alongside a standard 20% coinsurance for outpatient services, primary care, specialists, and diagnostics. For inpatient hospital stays, members pay a flat copayment of either $1,750 for acute care or $1,790 for psychiatric care per stay with no coinsurance. Emergency care is available with a $115 copay, while skilled nursing facility stays offer no copay for the first 20 days. Beyond basic medical care, this plan provides valuable supplemental benefits including dental, vision, and hearing coverage with no copays and generous annual allowances. Members can access up to $2,000 for dental care, $1,250 per ear for hearing aids, and $300 for eyewear with no copays or deductibles. Additionally, the plan covers up to 24 one-way transportation trips per year and offers a $125 monthly reimbursement for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Extra (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $1,750 copayment per stay for acute care and a $1,790 copayment per stay for psychiatric care. Prior authorization is required for these services, and while unlimited additional days are covered for acute stays, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra (HMO D-SNP) covers outpatient services, including outpatient hospital, 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.
Partial Hospitalization See details
Aetna Medicare Dual Extra (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Extra (HMO D-SNP), featuring a 20% coinsurance and no copay for emergency ground and air ambulance services. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Dual Extra (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, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit limit of $250,000.
Primary Care See details
Primary care benefits offered by Aetna Medicare Dual Extra (HMO D-SNP) are partially covered, as other chiropractic services are not covered. Most covered services, including primary care physician, specialist, and therapy visits, require no copay and a 20% coinsurance, while telehealth services feature no copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Extra (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and select supplemental benefits, but requiring a 20% coinsurance and no copay for services like glaucoma screenings and kidney disease education. Sub-services such as 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 are not covered.
Hearing Services See details
Aetna Medicare Dual Extra (HMO D-SNP) covers hearing services with no deductible, including annual routine exams for no copay and 20% coinsurance, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,250 per ear annually, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Extra (HMO D-SNP) with no copay and a 20% coinsurance for routine annual eye exams and follow-up diabetic eye exams. Eyewear, including contacts, lenses, frames, and upgrades, is also covered with no copay, up to 20% coinsurance, and no deductible, up to a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Extra (HMO D-SNP), offering up to $2,000 annually for preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require no copay and a 20% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs are covered with no copay and a coinsurance ranging from 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Dual Extra (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Aetna Medicare Dual Extra (HMO D-SNP) covers medical equipment—including durable medical equipment, prosthetics, and diabetic equipment—with no copays and prior authorization required. Coinsurance ranges from 0% to 20% depending on the item, featuring no coinsurance for diabetic supplies and up to 20% coinsurance for prosthetics, medical supplies, therapeutic shoes, and durable medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra (HMO D-SNP) with prior authorization required and no copayments. There is a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services carry no coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Dual Extra (HMO D-SNP) 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 (HMO D-SNP) with no copay and a 20% coinsurance. This benefit includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, all of which carry a 20% coinsurance and no copayment.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient 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 standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Extra (HMO D-SNP) partially covers other services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $125 monthly reimbursement for over-the-counter (OTC) items, chronic illness meal benefits, and additional wellness exams and cancer screenings.
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