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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 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 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 $23.80. 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 Care (HMO D-SNP) plan features an annual drug deductible of $615. Tier 1 preferred generic drugs are covered with no copay for one-, two-, or three-month fills at standard pharmacies and through mail order. Tier 2 generic prescriptions 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, costs are calculated using coinsurance rather than flat 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 cost-sharing percentages apply to both standard retail pharmacies and standard mail-order services.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) offers comprehensive medical coverage with no copay or coinsurance for primary care visits, telehealth, and routine preventive services. For specialized medical care, members pay predictable copays, such as $35 for specialists, $115 for emergency care, and daily copays for inpatient hospital stays. Outpatient services and ambulatory surgical centers are highly accessible, featuring no coinsurance and low-to-no copays for most visits. This plan also provides valuable supplemental benefits, including routine dental and vision care with no copay or coinsurance up to annual allowance limits of $1,250 and $200, respectively. Additionally, members benefit from hearing aid coverage up to $500 per ear, 12 one-way routine transportation trips, and a $40 monthly over-the-counter allowance with no copay or coinsurance. Other essential services like home health care feature no copay or coinsurance, while durable medical equipment and dialysis require a standard 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute stays require a $388 copay for days 1 to 7 and no copay thereafter, while psychiatric stays require a $673 copay for days 1 to 3 and no copay for days 4 to 90.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $388, and ambulatory surgical center services with no copay or coinsurance. Outpatient substance abuse services require prior authorization and carry a $40 copay for individual sessions and 20% coinsurance for group sessions, while outpatient blood services are provided with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Aetna Medicare Dual Care (HMO D-SNP) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Care (HMO D-SNP), featuring a $295 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and no copay for air ambulance services. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related 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 and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by Aetna Medicare Dual Care (HMO D-SNP) because other chiropractic services are not covered, while primary care physician visits and telehealth are available with no copay and no coinsurance. Other covered services feature no coinsurance and require copays, including $25 for therapy services, $35 for specialists and podiatry, and $40 for mental health, psychiatric, and opioid treatment sessions.
Preventive Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers preventive services, with most covered benefits like annual physicals and glaucoma screenings requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, medical nutrition therapy, weight management programs, alternative therapies, therapeutic massage, and adult day health services.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers hearing services, offering Medicare-covered exams for a $35 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no deductibles, offering one routine eye exam per year with a 20% coinsurance and no copay, alongside unlimited follow-up diabetic eye exams with no copay. Eyewear, including lenses, frames, and contact lenses, is covered with no copay or coinsurance up to a combined maximum benefit of $200 every year.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $1,250 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy and other Part B drugs carry no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, requiring prior authorization. Diabetic equipment is also covered with no copay, featuring no coinsurance for manufacturer-specified diabetic supplies and a 20% coinsurance for therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Aetna Medicare Dual Care (HMO D-SNP), with prior authorization required. Diagnostic procedures and diagnostic radiological services require a copay but have no coinsurance, while lab services and outpatient X-rays feature no copay, and therapeutic radiological services require a 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) offers Cardiac Rehabilitation Services where some services are covered, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. If received, these services require a 20% coinsurance for cardiac and pulmonary rehabilitation, a $40 copay for intensive cardiac rehabilitation, and a $20 copay for SET for PAD.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day inpatient hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the Aetna Medicare Dual Care (HMO D-SNP) are partially covered, offering eligible members chronic illness meals, additional preventive screenings, and a $40 monthly over-the-counter reimbursement with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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