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Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full 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 Full Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 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 Full 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 Full 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 Full 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 Full 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.
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:
Sign up for Aetna Medicare Full Dual Care (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Full Dual Care (HMO D-SNP) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. If you qualify for the Full Low-Income Subsidy, your Part D cost is reduced to $0.00. After meeting the deductible, you will pay a share of the cost for prescription medications during the initial coverage phase until total drug costs reach $2,100.00. For a 30-day supply, Tier 1 preferred generics have no copay at standard pharmacies and standard mail. Tier 2 standard generics require 22% coinsurance, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 25% coinsurance. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) offers robust medical coverage, featuring inpatient hospital stays with a 1,860 dollar copay and no coinsurance, alongside outpatient services that have no copay and a 20 percent coinsurance. For urgent and emergency needs, members pay a 115 dollar copay for emergency room visits and a 40 dollar copay for urgent care. Additionally, routine primary care and specialist visits are covered with no copay and a 20 percent coinsurance. This plan also provides valuable supplemental benefits, including dental services with a 2,500 dollar annual limit and no copay or coinsurance for most preventive and comprehensive care. Vision and hearing benefits feature no copay for routine exams, plus allowances for eyewear and up to 1,250 dollars per ear annually for prescription hearing aids with no copay. Other highlights include no copay and no coinsurance for home health services, select preventive care, and a 150 dollar monthly over-the-counter allowance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), requiring a $1,860 copay and no coinsurance per stay for acute and psychiatric admissions. While unlimited additional acute stay days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Aetna Medicare Full Dual Care (HMO D-SNP) are covered with a 20% coinsurance and no copay for outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization benefits, subject to prior authorization. Covered services require a $110.00 copay and 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), as transportation to any health-related location is not covered. Ground and air ambulance services require a 20% coinsurance and no copay, while up to 24 annual one-way trips to plan-approved locations are covered with no copay and no coinsurance.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist visits, and therapy services, generally requiring a 20% coinsurance and no copay. Additional telehealth benefits are available with no copay, while routine chiropractic and podiatry visits are covered with a 20% coinsurance and no copay.
Preventive Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) provides partially covered preventive services, offering no copay and no coinsurance for annual physicals, fitness benefits, health education, and smoking cessation. Kidney disease education, glaucoma screenings, and diabetes self-management training are covered with a 20% coinsurance and no copay, while services like weight management, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers hearing services, offering routine exams and fitting evaluations with no copay and no deductible, though routine exams require up to 20% coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $1,250 annual limit per ear, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers routine eye exams with no copay and 20% coinsurance, and follow-up diabetic eye exams with no copay and no coinsurance. The plan also provides a $325 annual eyewear allowance, featuring contact lenses with no copay and 20% coinsurance, and eyeglasses, lenses, frames, and upgrades with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered under Aetna Medicare Full Dual Care (HMO D-SNP), which offers a $2,500 annual limit with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers home infusion bundled services, requiring prior authorization and featuring step therapy. Patients pay a $35 copay and no coinsurance for Medicare Part B insulin, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required before you can receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies are available with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copayments, although prior authorization is required. Covered services, including diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays, carry a 20% coinsurance, while diagnostic radiological services range from no coinsurance up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) indicates that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. As a result, there is no copay and no coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and offering no copay for days 1 to 20 followed by a $218 daily copay for days 21 to 100. Additional days beyond the Medicare-covered SNF limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Full Dual Care (HMO D-SNP) plan, as acupuncture and dual eligible SNPs with highly integrated services are not covered. Covered benefits—including chronic illness meals, select wellness exams, and a $150 monthly over-the-counter item allowance—are offered with no copay and no coinsurance.
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