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Aetna Medicare Assure (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure (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 (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Greater Rochester Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.80. 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 $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 (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible is met, the plan covers the cost of your medications. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs. The plan's premium is $57.80 per month for those who qualify for the low-income subsidy.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits. Inpatient hospital stays require prior authorization and have a copay of $2,185 per admission for acute care, and $2,036 for psychiatric care. Outpatient services, including observation, ambulatory surgical center, and substance abuse services, have a 20% coinsurance. This plan also covers a variety of services with varying cost-sharing. Emergency services have a $110 copay, while primary care, specialist visits, and therapies typically have a 20% coinsurance. Preventive services, including an annual physical exam, and many dental services have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $2,185 per admission or stay, while for Inpatient Hospital Psychiatric, the copay is $2,036 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services with the Aetna Medicare Assure (HMO D-SNP) plan include coverage for all outpatient hospital services, with a 20% coinsurance. Observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services are covered with a 20% coinsurance. Outpatient blood services are also covered with a 20% coinsurance, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure (HMO D-SNP) plan, but requires prior authorization. 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 (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and 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 by the Aetna Medicare Assure (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have varying copays, with Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each having no copay.
Primary Care See details
The Aetna Medicare Assure (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, 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. Occupational therapy, mental health specialty services, psychiatric services, and opioid treatment program services have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Other health care professional services have a coinsurance between 0% and 20%. Additional telehealth benefits have no copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and some services, like in-home safety assessments, are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and a copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with no copay for prescription hearing aids (all types), but with a maximum copay of $1,700. OTC hearing aids, prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and routine eye exams and other eye exam services with no copay. Eyewear benefits are covered with a 20% coinsurance, and a $100 combined maximum benefit per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all of which have no copay.
Dental Services See details
Aetna Medicare Assure (HMO D-SNP) covers dental services, including Medicare dental services with 20% coinsurance and other dental services with no copay for oral exams, dental x-rays, other diagnostic services, prophylaxis, fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral/maxillofacial surgery, but orthodontics is not covered. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis, fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral/maxillofacial surgery are limited to one visit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Assure (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of up to 20%, while Diagnostic Radiological Services have no coinsurance, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the sub-services are covered. The plan does not specify any cost sharing information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Assure (HMO D-SNP), but require prior authorization. The plan does not cover additional days beyond Medicare-covered days, or non-Medicare-covered stays.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture and several other services are not covered. OTC items have a maximum benefit of $30.00 every month.
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