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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Jefferson and Orleans Parishes. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 $6750.00 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 Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $2 copay for a one-month supply. Tier 2 generic medications cost as low as a $5 copay for a one-month supply at preferred locations, compared to a $12 copay at standard pharmacies. Higher-tier prescription drugs transition to coinsurance, with Tier 3 preferred brands requiring a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services helps policyholders minimize out-of-pocket expenses under this plan.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, routine podiatry, and annual physical exams. Specialist visits range from no copay to a $30 copay, while emergency care requires a $130 copay which is waived if you are admitted. For hospital stays, members pay no coinsurance, though inpatient acute stays require a $375 daily copay for the first six days and outpatient services feature copays up to $399. This plan also includes valuable everyday benefits, offering routine dental, vision, and hearing exams with no copay and no coinsurance. Members receive up to $300 annually for eyewear and up to $500 per ear for prescription hearing aids with no copay. Additionally, skilled nursing facility stays have no copay for the first 20 days, and durable medical equipment is covered with no copay and 0% to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $350 daily copay for days 1 to 6 of psychiatric stays (no copay for days 7 to 90). Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Chronic Care (HMO C-SNP) are covered with no coinsurance, featuring no copay to a $399 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay or coinsurance, while outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance and copays of $130 for medical care and $250 for emergency transportation, up to a maximum benefit limit of $250,000.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) offers primary care and routine podiatry services with no copay and no coinsurance, while specialist visits cost a $0 to $30 copay with no coinsurance. Physical, occupational, mental health, psychiatric, and opioid treatment therapies require copays ranging from $25 to $35 with no coinsurance, whereas telehealth services have a $0 to $40 copay and 20% coinsurance, and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers annual physical exams and Medicare-covered preventive services with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance with no copay. Additional preventive benefits are partially covered, offering health education, smoking cessation counseling, memory fitness, and remote access technologies with no copay and no coinsurance, while services like in-home safety assessments and weight management programs are not covered.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Medicare-covered hearing exams for a $30 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but over-the-counter (OTC) hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, featuring a $0 to $30 copay for eye exams and no copay for an annual routine exam. Eyewear, including contact lenses and eyeglasses, is also covered with no copay and no coinsurance up to a $300 combined annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive exams, cleanings, and x-rays. Comprehensive services like restorative care and endodontics are covered with no copay and 20% to 50% coinsurance up to a $3,000 annual maximum, while fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers durable medical equipment and medical supplies with no copay and 0% to 20% coinsurance, while prosthetic devices carry no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes are also covered with no copay and no coinsurance from specified manufacturers, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with prior authorization required. Diagnostic tests and lab services feature no coinsurance and copays ranging from no copay up to $20, while radiological services require a $20 copay for x-rays and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance. While some services are covered, specific sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation—are not covered in practice.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services 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
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered Other Services with no copay and no coinsurance, including annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $61 monthly in reimbursed over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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