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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 2025 to people living in Metro Area: LI, 5 Boroughs, Westchester/Rockland. This plan received an overall rating of 3 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 $58.80. 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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. For generic medications, this plan offers excellent savings with no copay for both Tier 1 Preferred Generic and Tier 2 Generic drugs when filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supplies. For higher-tier medications, the plan transitions to a coinsurance model for standard pharmacy and mail-order fills. You will pay a 22% coinsurance for Tier 3 Preferred Brand drugs, and a 25% coinsurance for Tier 4 Non-Preferred drugs. Tier 5 Specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) offers comprehensive medical coverage, featuring no copays for primary care and specialist visits, though they are subject to a 20% coinsurance. Inpatient hospital stays require a copay of $2,120 per stay for acute care and $2,080 for psychiatric care, both with no coinsurance. Outpatient and diagnostic services generally carry a 20% coinsurance with no copay, while emergency room visits require a $115 copay. This plan provides strong supplemental benefits, including dental care with no copay and vision exams with no copay and a 20% coinsurance. Members also benefit from home health services with no copay or coinsurance, routine hearing exams with no copay, and a $165 monthly over-the-counter reimbursement. Skilled nursing facility care is covered with no coinsurance, requiring no copay for the first 20 days and a $218 copay for days 21 through 100.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,120 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Unlimited additional acute days are covered, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient 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 pay either 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. For transportation, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services under the Aetna Medicare Full Dual Care (HMO D-SNP) are covered with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance, featuring a $115 copay for emergency or urgent care and no copay for emergency transportation.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist visits, therapies, psychiatric, and mental health services with no copay and a 20% coinsurance. Additional telehealth benefits are covered with no copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physical exams and select supplemental benefits. Kidney disease education and other screenings carry a 20% coinsurance with no copay, whereas services like weight management, nutritional therapy, and alternative therapies are not covered.
Hearing Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers hearing services with no deductible, featuring no copay and no coinsurance for Medicare-covered exams and fitting evaluations, and a 20% coinsurance with no copay for annual routine exams. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no deductible, offering annual routine eye exams and follow-up diabetic exams with no copay and a 20% coinsurance. Eyewear including eyeglasses and contact lenses is also covered with no copay (and a 20% coinsurance for contacts) up to a $100 annual maximum limit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), with orthodontic services not covered under the plan. Medicare-covered dental services require no copay and a 20% coinsurance, while other preventive and comprehensive dental services are offered with no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs carry a coinsurance ranging from 0% (no coinsurance) to 20%, while covered Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers medical equipment with no copays, although prior authorization is required. Under this plan, diabetic supplies have no coinsurance, while durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% 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 copayments. You will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required before receiving these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers cardiac rehabilitation services with no copay, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 copayment for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, featuring up to 12 acupuncture treatments per year, a $165 monthly over-the-counter reimbursement, chronic illness meal benefits, and wellness screenings. Highly integrated services for dual-eligible SNPs are not covered under this plan.
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