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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 Select LA Parishes. 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 $23.90. 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 Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order. Tier 2 generic prescription drugs require a standard 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, standard cost sharing shifts to coinsurance rather than set copays. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply to standard pharmacy and standard mail order options, helping you evaluate your out-of-pocket costs for more specialized prescriptions.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) plan offers comprehensive coverage for core medical services, generally featuring no copays alongside a standard 20% coinsurance for outpatient care, doctor visits, and dialysis. Inpatient hospital stays require a $1,550 copay per stay with no coinsurance, while emergency services carry a $115 copay. Routine vision and hearing services feature no deductibles, and the plan offers a generous $3,000 annual allowance for dental care with no copay or coinsurance. Members can also take advantage of valuable extra benefits, including up to 24 one-way transportation trips per year and a monthly $170 allowance for over-the-counter items with no copay. Home health services, diagnostic radiological services, and skilled nursing facility stays for the first 20 days are all covered with no copay and no coinsurance. Additionally, prescription hearing aids are covered up to $500 per ear and eyewear up to $300 annually with no copay.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers inpatient acute hospital stays with a $1,550 copay per stay and inpatient psychiatric stays with a $1,630 copay per stay, both requiring prior authorization and featuring no coinsurance. While acute hospitalizations include unlimited additional days, this benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra Care (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 covered outpatient services.
Partial Hospitalization See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the coverage tier, you will either pay no copay with a 20% coinsurance, or a $110.00 copay with no 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, with prior authorization required. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no 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 admitted to the hospital within 24 hours, while urgently needed services require 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 of $250,000.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth services feature no copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), with annual physicals and select fitness benefits requiring no copay and no coinsurance, while kidney education and screenings like glaucoma require no copay and 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, including one annual routine exam with a 20% coinsurance and no copay, and one yearly fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually (inner, outer, and over-the-ear types are not covered), while OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, offering one routine eye exam per year with no copay and a 20% coinsurance, alongside follow-up diabetic eye exams with no copay. Eyewear is covered with no copay up to a $300 annual limit, though contact lenses carry a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), featuring a $3,000 annual limit for preventive and comprehensive care with no copay and no coinsurance. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required and coinsurance ranges from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copays and prior authorization required. Diabetic supplies feature no coinsurance, while durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers diagnostic and radiological services with no copays, subject to prior authorization. Under this plan, diagnostic radiological services have no coinsurance, while diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Some cardiac rehabilitation services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no three-day prior hospital stay. There is no copay for days 1 through 20, followed by a $218 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 Care (HMO D-SNP) partially covers other services, offering no copay and no coinsurance for meal benefits, wellness exams, screening mammographies, additional gFOBT and FIT screenings, and a monthly $170 over-the-counter allowance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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