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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual 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 Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in AL - Statewide. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual 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 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 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 Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 Care (HMO D-SNP) plan features an Enhanced Alternative drug benefit with a prescription drug deductible of $615.00, which is reduced to $0.00 for individuals who qualify for the low-income subsidy. During the initial coverage phase, Tier 1 preferred generic drugs have no copay at standard pharmacies and through standard mail. For other tiers, you will pay a 22% coinsurance for Tier 2 standard generic drugs and a 25% coinsurance for both Tier 3 preferred brand and Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase. During this phase, you pay nothing for Medicare Part D covered drugs. This transition ensures your prescription medication costs are fully covered after reaching the out-of-pocket limit.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for primary care visits, telehealth, home health, and most preventive services. For specialized medical needs, members can expect predictable costs, including a $10 to $40 copay for specialist visits and no coinsurance for inpatient hospital stays, which carry daily copays for initial days. Emergency care is available with a $115 copay, while ground ambulance services require a $285 copay, both with no coinsurance. In addition to core medical care, this plan provides valuable supplemental benefits to support overall wellness, including routine dental, vision, and hearing services with no copays. Members benefit from a $1,200 annual dental allowance, a $350 annual eyewear allowance, and up to $500 per ear annually for prescription hearing aids. The plan also features up to 12 one-way transportation trips to plan-approved locations with no copay and a $40 monthly reimbursement for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no coinsurance for all covered stays. Acute care requires a $388 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $678 daily copay for days 1-3 and no copay for days 4-90. Non-Medicare-covered stays, acute room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under Aetna Medicare Dual Care (HMO D-SNP), featuring no copay or coinsurance for ambulatory surgical center and blood services. Outpatient hospital and observation services require no coinsurance with copays ranging from $0 to $388, while outpatient substance abuse services carry a $40 copay with no coinsurance for individual sessions and a 20% coinsurance with no copay for group sessions.
Partial Hospitalization See details
Aetna Medicare Dual Care (HMO D-SNP) covers partial hospitalization benefits with a copay ranging from $105.00 to $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ground ambulance services with a $285 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 12 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
Aetna Medicare Dual Care (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $25 copay, with no coinsurance required for either. Worldwide emergency and urgent services are covered with no copay, while worldwide emergency transportation has a $285 copay, up to a $250,000 maximum benefit with no coinsurance.
Primary Care See details
Primary Care benefits are covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for primary care physician visits and telehealth services. Other covered services, including specialist visits, physical therapy, and mental health services, require copays ranging from $10 to $40 with no coinsurance.
Preventive Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers most preventive services with no copay and no coinsurance, including annual physicals, glaucoma screenings, and select fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. However, supplemental benefits are only partially covered, excluding in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring routine hearing exams and fittings with no copay, Medicare-covered exams with a $15 copay, and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services, offering annual routine eye exams and diabetic eye exams with no copay, and other exams with copays up to $15, all with no coinsurance. Additionally, members receive a $350 annual allowance for eyewear, including contacts and eyeglasses, with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) up to a $1,200 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require prior authorization and carry a $15 copay with no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan, requiring prior authorization. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required for this covered benefit.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and no coinsurance, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Care (HMO D-SNP), though prior authorization is required. Lab tests and outpatient X-rays feature no copay or coinsurance, diagnostic procedures carry a $0 to $95 copay with no coinsurance, and radiological services require up to 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Care (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services—are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay for days 1 to 20, a $218 daily copay for days 21 to 100, and no coinsurance. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Care (HMO D-SNP) offers partially covered other services with no copay and no coinsurance, including meal benefits, wellness exams, and a $40 monthly over-the-counter item reimbursement. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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