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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 Lafayette, Alexandria, Lake Charles and Monroe. 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 $39.10. 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:
Sign up for Aetna Medicare Dual Preferred (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Dual Preferred (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your Part D premium will be $39.10. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2,000, at which point you enter the next coverage phase. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1905 copay per admission. Outpatient services, including doctor visits, have a 20% coinsurance. Emergency services have a $110 copay, while preventive services, such as annual physical exams, have no copay. This plan provides coverage for hearing aids, vision care, and dental services, with specific copays and coinsurance. The plan also includes additional benefits like home health services with no copay, over-the-counter items with a monthly allowance, and transportation services with no copay for plan-approved health-related locations, making it a comprehensive option for those seeking extensive coverage.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. The copay for a Medicare-covered stay is $1905.00 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, outpatient substance abuse services (individual and group sessions), and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance, and the plan waives the deductible for three pints of blood. Individual and group sessions for outpatient substance abuse have a coinsurance of 20%.
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 both ground and air ambulance services, with a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 36 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; Worldwide Emergency Services have a $0 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 20% coinsurance, and covers chiropractic services with a 20% coinsurance and routine care with no copay. The plan also covers 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 with no copay, and opioid treatment program services.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services including health education, wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and home and bathroom safety devices, all with a $0 copay. 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, with routine hearing exams and fitting/evaluation for hearing aids covered with no copay and routine hearing exams subject to a 20% coinsurance. Prescription hearing aids are covered with a maximum benefit of $500 per year with no copay, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum plan benefit coverage amount of $410.00 every year for eyewear.
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, and restorative services are covered with no copay. Medicare Dental Services are covered with 20% coinsurance. 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, but require prior authorization. You will pay 20% coinsurance for these services.
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. All diagnostic services, including procedures, tests, and lab services, have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have no copay and a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services have no copay and a coinsurance of at most 20%.
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. 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. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $205 per month, and includes nicotine replacement therapy and Naloxone coverage. Other covered services include a meal benefit with no copay, as well as annual wellness exams and screening mammography with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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