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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 LA - 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 $6.50. 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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For brand-name and specialty prescriptions, cost-sharing is based on coinsurance at standard pharmacies and standard mail order. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 25% coinsurance. Tier 5 (Specialty) medications also require a 25% coinsurance, which is available for a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) offers robust medical coverage, featuring no copays for primary care and specialist visits, though a 20% coinsurance typically applies. For hospital stays, members pay no coinsurance but are responsible for a copay of $1,850 per acute inpatient stay and $1,860 per psychiatric stay, while emergency visits require a $115 copay that is waived if admitted. Outpatient services and diagnostic tests generally carry a 20% coinsurance with no copays. This plan also provides excellent supplemental benefits, including home health services and up to 36 one-way transportation trips per year with no copay and no coinsurance. Members receive a $3,500 annual allowance for select dental services, up to $1,250 per ear annually for hearing aids, and a $350 annual eyewear allowance, all with no copays. Additionally, the plan includes a monthly allowance of up to $235 for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $1,850 copay per stay for acute care and a $1,860 copay per psychiatric stay. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will either pay a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum benefit with no copays and no coinsurance.
Primary Care See details
Primary care and specialist services under the Aetna Medicare Full Dual Care (HMO D-SNP) plan generally feature no copay and a 20% coinsurance, while additional telehealth benefits are available with no copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Full Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney disease education and other screenings require a 20% coinsurance and no copay. Sub-services not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling services.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering Medicare-covered exams and fitting evaluations with no copay or coinsurance, alongside annual routine exams with a 20% coinsurance and no copay. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductible, including one annual routine eye exam with no copay and a 20% coinsurance. Eyewear is covered up to a $350 annual maximum, offering eyeglasses and frames with no copay or coinsurance, and contact lenses with no copay and a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering Medicare-covered dental with no copay and a 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,500 yearly maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance.
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 for these services.
Medical Equipment See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and medical supplies carry a coinsurance of 0% to 20%, prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance, and diabetic supplies have no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Under this plan, diagnostic radiological services have no coinsurance, while other diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Full Dual Care (HMO D-SNP) plan. Sub-services including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, including chronic illness meals, annual wellness exams, select colorectal screenings, and up to $235 monthly for over-the-counter items. Acupuncture, highly integrated dual-eligible SNP services, and certain other services are not covered under this plan.
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