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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 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 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 $23.30. 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 $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 and offers cost-effective options for your prescription medications. You will pay no copay for Tier 1 preferred generic drugs obtained through standard pharmacies or standard mail order services. For Tier 2 generic drugs, standard pharmacy and standard mail order fills cost a flat 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 based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance for standard pharmacy and standard mail order fills. This structure helps you easily plan your out-of-pocket drug costs under this Aetna Medicare Advantage plan.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, annual physicals, and home health care. Members also benefit from generous routine care allowances, including no copay for routine dental services up to $2,000 annually, routine vision exams with a $250 eyewear allowance, and up to 12 free one-way transportation trips per year. Additionally, the plan includes valuable extras like a $70 monthly over-the-counter allowance and acupuncture sessions with no copay. For specialized medical needs, specialist visits require a $30 copay and urgent care has a $15 copay, both with no coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, while inpatient hospital stays require a $380 copay for the first seven days and no copay thereafter. Most outpatient hospital services and diagnostic tests are covered with variable copays and no coinsurance, though certain services like durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no coinsurance, though prior authorization is required. Acute stays require a $380 copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $1,950 copay per stay; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient hospital services with no coinsurance and a $0 to $450 copay, and observation services with no coinsurance and a $380 copay per stay. Ambulatory surgical and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services feature no copay but require a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Dual Care (HMO D-SNP) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Care (HMO D-SNP), featuring a $290 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation is partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Care (HMO D-SNP) 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 $15 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Additional services like physical therapy ($35 copay) and mental health ($40 copay) have no coinsurance, and chiropractic services are partially covered with no coinsurance because other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance for annual physicals and most services, though kidney disease education requires a 20% coinsurance and no copay. Excluded services include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) provides partially covered hearing services, featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner, outer, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services under the Aetna Medicare Dual Care (HMO D-SNP) plan feature no coinsurance, with a $0 to $30 copay for Medicare-covered exams and no copay for annual routine or diabetic eye exams. Covered eyewear, including contacts, eyeglasses, frames, and upgrades, has no copay and no coinsurance up to a combined maximum benefit of $250 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), offering no copay and no coinsurance for most preventive and comprehensive care up to a $2,000 annual maximum. Medicare-covered dental services require a $30 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay, subject to prior authorization and step therapy. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance, with prior authorization required. Diabetic supplies are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $95. Covered radiological services require prior authorization, featuring outpatient X-rays with no copay and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers some Cardiac Rehabilitation Services with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance, including up to 20 acupuncture treatments per year, a $70 monthly over-the-counter allowance, a chronic illness meal benefit, and additional wellness and cancer screenings. However, this benefit is only partially covered as highly integrated services and certain other services are not covered.
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