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Aetna Medicare Assure Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Plus (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 Assure Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Plus (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro Brooklyn. The overall rating for this plan is not yet available for 2025.
It's important to know that Aetna Medicare Assure Plus (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 Assure Plus (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 Assure Plus (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 Assure Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $55.90. 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 $590.00 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 $9350.00 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 Assure Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs, but the specific costs for different drug tiers are not listed in this summary. Once your total drug costs reach $2,000, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $55.90 for Part D.
Additional Benefits
The Aetna Medicare Assure Plus (HMO D-SNP) plan offers coverage for a variety of services. This plan includes inpatient hospital stays with a copay, and outpatient services with coinsurance. The plan also includes coverage for primary care services, preventive services, and dental services with various copays and coinsurance amounts. Additionally, the plan offers benefits such as ambulance services, emergency services, and home health services, while some other services may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered under the Aetna Medicare Assure Plus (HMO D-SNP) plan. For inpatient hospital-acute services, you will have a copay of $2,185 per admission or stay. For inpatient hospital-psychiatric services, you will have a copay of $2,036 per admission or stay. Additional days, upgrades, and non-medicare covered stays for both acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient Blood Services have a 20% coinsurance, and this plan waives the three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and no coinsurance. Urgently Needed Services have a $45 copay, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have no copay, and Worldwide Emergency Transportation has no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance, while Additional Telehealth Benefits have no coinsurance. Individual and Group Sessions for Mental Health and Psychiatric Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance for Medicare-covered services and Routine Foot Care has no coinsurance. Other Health Care Professional services have a coinsurance between 0% and 20%, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services, including an annual physical exam, are covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan. The plan has no copay for the annual physical exam, and covers other preventive services with a 20% coinsurance for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services are partially covered under the Aetna Medicare Assure Plus (HMO D-SNP) plan. While hearing exams are covered with a 20% coinsurance, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan. Eye exams are covered with 20% coinsurance, while routine eye exams are not covered. Eyewear is covered with 20% coinsurance, though contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered under the Aetna Medicare Assure Plus (HMO D-SNP) plan. Medicare dental services have a 20% coinsurance and require prior authorization, while other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery, all with no copay. Orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan, with a 20% coinsurance for Durable Medical Equipment (DME), Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. There is no copay for any of these services. Diagnostic procedures/tests, lab services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%, and diagnostic radiological services have a coinsurance of 0%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan with no coinsurance and no copay. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Plus (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. The copay for SNF services is not specified in this snippet.
Other Services See details
The Aetna Medicare Assure Plus (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum plan benefit coverage amount of $180 per month. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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