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Aetna Medicare Full Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Full Dual (HMO D-SNP) is a HMO D-SNP plan offered by Aetna Health Inc. (NY) available for the 2026 plan year to people living in Upstate NY Area: HV, Capital, CNY, WNY. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.10. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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 (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Full Dual (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Members benefit from no copay on Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail-order services. This cost-saving coverage applies to one-month, two-month, and three-month supplies of these generic medications. For brand-name and specialty prescriptions, costs are based on a percentage of the drug cost rather than a flat fee. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply to standard pharmacy and standard mail-order fills, with specialty tier coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) offers comprehensive medical coverage, with many essential services requiring no copay, though coinsurance and specific copays still apply. For instance, primary, specialist, and outpatient visits feature no copay and a 20% coinsurance, while inpatient hospital stays require a copay of $2,175 for acute care. Emergency services carry a $115 copay, which is waived upon hospital admission, and home health services are fully covered with no copay and no coinsurance. For routine care, the plan provides dental services with no copay and no coinsurance for most preventive and comprehensive care. Routine vision and hearing exams also feature no copay, though they are subject to a 20% coinsurance, alongside eyewear coverage of up to $200 annually. Members also receive a $140 monthly over-the-counter reimbursement and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,175 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services with the first three pints waived.
Partial Hospitalization See details
Aetna Medicare Full Dual (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will owe either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Full Dual (HMO D-SNP) with a 20% coinsurance and no copay for ground and air ambulance services, which require prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are covered up to a $250,000 limit with no coinsurance, requiring a $115 copay for emergency and urgent care and no copay for emergency transportation.
Primary Care See details
Primary care benefits under Aetna Medicare Full Dual (HMO D-SNP) are offered with no copay and 20% coinsurance for most services, including primary care, specialist, therapy, and mental health visits. Chiropractic services are partially covered, offering up to 12 routine care visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered. Additional telehealth benefits are also available with no copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), featuring no copay and no coinsurance for annual physicals, health education, and fitness benefits. Other covered services like kidney disease education and glaucoma screenings have no copay but require a 20% coinsurance, while services such as weight management, therapeutic massage, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers routine hearing exams with no copay and 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $1,700, while inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers vision services with no deductibles, including one routine eye exam per year and follow-up diabetic eye exams with no copay, though routine exams are subject to a 20% coinsurance. Eyewear is covered up to a $200 annual maximum with no copay, which includes eyeglasses and contact lenses, the latter of which require a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance, and other preventive and comprehensive services with no copay and no coinsurance. While most diagnostic, preventive, restorative, and surgical dental services are fully covered, orthodontics is not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Aetna Medicare Full Dual (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays, though prior authorization is required. While diabetic supplies feature no coinsurance, other medical equipment, prosthetics, and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. There is no coinsurance for diagnostic radiological services, but a 20% coinsurance applies to diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual (HMO D-SNP) features no copay for cardiac rehabilitation, but in practice, only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Full Dual (HMO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, 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 (HMO D-SNP) with no copay and no coinsurance, excluding highly integrated services for dual eligible SNPs and certain other services. Covered benefits include up to 12 acupuncture treatments per year, a $140 monthly over-the-counter reimbursement, chronic illness meals, and select wellness exams.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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