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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 HVP Counties in 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 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 $23.80. 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 Extra Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies through standard pharmacies and mail order. Tier 2 generic medications require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance for standard pharmacy and mail-order services. These coinsurance rates apply to one-, two-, and three-month supplies, except for Tier 5 specialty drugs, which are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) plan offers comprehensive medical coverage, featuring an inpatient hospital copayment of $2,030 per admission and outpatient services with no copays and a standard 20% coinsurance. Emergency care is available with a $115 copay, which is waived if admitted, while primary care visits and many diagnostic services generally require no copay and a 20% coinsurance. This plan provides strong supplemental benefits, including dental care with no copay or coinsurance up to a $2,000 annual limit and vision hardware covered up to $300 yearly. Additionally, members can take advantage of hearing aid coverage up to $500 per ear, free home health services, and a monthly allowance of up to $108 for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital stays are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with a $2,030 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are provided with no copayment.
Outpatient Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services with the cost of the first three pints waived.
Partial Hospitalization See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the specific service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 24 annual one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are fully covered with no copays or coinsurance up to a $250,000 maximum limit.
Primary Care See details
Primary care benefits under Aetna Medicare Dual Extra Care (HMO D-SNP) are generally covered with no copay and 20% coinsurance, while additional telehealth services are available with no copay and no coinsurance. Chiropractic services are partially covered, offering routine care with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers preventive services, offering an annual physical exam and select supplemental benefits with no copay and no coinsurance. Other covered services, including kidney disease education and glaucoma screenings, require no copay but have a 20% coinsurance, while several sub-services like weight management and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, offering Medicare-covered exams and fitting evaluations with no copay or coinsurance, and routine exams with a 20% coinsurance and no copay. Prescription hearing aids are covered with no copay or coinsurance up to $500 per ear annually, though OTC, inner ear, outer ear, and over the ear 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, including one annual routine eye exam and contact lenses, which both have a 20% coinsurance and no copay. Eyeglasses, frames, lenses, and upgrades are covered with no copay and no coinsurance, subject to a $300 combined annual maximum.
Dental Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $2,000 annual limit, while Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
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. Associated Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment benefits under the Aetna Medicare Dual Extra Care (HMO D-SNP) are covered with no copay, though prior authorization is required. A 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) with no copays, though prior authorization is required. Covered lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services are offered with no 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no copay under Aetna Medicare Dual Extra Care (HMO D-SNP), but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day inpatient hospital stay is not required prior to admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan, with covered benefits requiring no copay and no coinsurance. Covered services include chronic illness meals, wellness exams, and up to $108 monthly for over-the-counter items, while acupuncture is not covered.
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