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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 MS. 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 $42.30. 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 cost-sharing for your drugs in each tier. Once your total drug costs reach $2000, you will enter the next coverage phase. 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 wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $1570 copay, while outpatient services and partial hospitalization have a 20% coinsurance. Emergency services have a copay of $110, and primary care services often have a 20% coinsurance, but many other services, such as routine chiropractic and vision exams, have no copay. Preventive services, home health services, and over-the-counter items are covered with no copay, offering significant value. The plan also includes coverage for hearing, vision, and dental services, but specific cost-sharing details vary by service, with many services having a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $1570 per admission or stay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute are covered with no copay, but 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, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance of 20%. Outpatient blood services are covered with a 20% coinsurance, and the plan waives the 3-pint deductible.
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 service.
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; transportation to any other health-related location is 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 has a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Primary Care Physician Services, Occupational Therapy, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a 20% coinsurance. Routine Chiropractic Care has no copay, while other Chiropractic Services have a coinsurance of 20%. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Routine Foot Care has a 20% coinsurance and Medicare-covered Podiatry Services have no copay. Other Health Care Professional services have a coinsurance between 0% and 20%. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive Services include several services, like an annual physical exam, with no copay. Other services like Glaucoma Screenings, Diabetes Self-Management Training, and Barium Enemas have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per year, with no copay for all types of prescription hearing aids except for inner, outer, and over-the-ear hearing aids, which are not covered.
Vision Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have a 20% coinsurance, and a maximum plan benefit of $465 per year.
Dental Services See details
Dental services are covered with a 20% coinsurance for Medicare Dental Services. 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. Maxillofacial prosthetics, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. 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. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Dual Preferred (HMO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and 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, with no copay for any services. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%.
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. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but no specific details about the cost sharing are provided. However, the plan 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 the cost sharing details are not provided. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers over-the-counter items with no copay, and a $175 maximum plan benefit coverage amount every month, as well as a meal benefit and other services with no copay. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and several other services are not covered.
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