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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 Greater Rochester Area. 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 $36.20. 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 coverage features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at standard pharmacies or through standard mail order. This zero-cost coverage applies to one-month, two-month, and three-month supplies of these generic medications. For higher-tier medications, costs are based on a percentage of the drug's price. 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 at standard pharmacies or through standard mail order.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) plan offers robust medical coverage with variable cost-sharing depending on the service you receive. For inpatient hospital stays, members are responsible for a $2,230 copay for acute stays and a $2,080 copay for psychiatric stays, with no coinsurance. Most outpatient care, primary care visits, specialist consultations, and diagnostic testing feature no copay but require a 20% coinsurance. Many everyday health benefits, including preventive care, routine dental, home health services, and eyeglasses, are fully covered with no copay and no coinsurance. Routine hearing exams and medical equipment typically require a 20% coinsurance, while prescription hearing aids range from no copay up to a $1,700 copay. Additionally, the plan includes a $30 monthly over-the-counter reimbursement and covers emergency room visits with a $115 copay.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) inpatient hospital services are partially covered and require prior authorization, with no coinsurance for all stays. Acute stays require a $2,230 copay per stay with no copay for unlimited additional days, while psychiatric stays require a $2,080 copay per stay, but upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. 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 (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, your cost-sharing will be either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care are covered up to $250,000 with a $115 copay and no coinsurance, and worldwide emergency transportation is available with no copay or coinsurance.
Primary Care See details
Primary care benefits under the Aetna Medicare Full Dual (HMO D-SNP) plan are partially covered, offering primary care, specialist, psychiatric, and physical therapy visits with no copay and 20% coinsurance. While additional telehealth benefits are covered with no copay and no coinsurance, podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services under the Aetna Medicare Full Dual (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for annual physicals, health education, and fitness benefits. While kidney disease education and specific screenings have no copay but require a 20% coinsurance, other services like medical nutrition therapy, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers hearing services with no deductible, offering routine exams and fitting evaluations with no copay, though routine exams require a 20% coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700, but OTC hearing aids and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers vision services with no deductible, offering one routine eye exam per year and contact lenses with a 20% coinsurance and no copay. Eyeglasses, lenses, frames, upgrades, and follow-up diabetic eye exams are covered with no copay and no coinsurance, with eyewear subject to a combined annual maximum benefit of $100.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), featuring no copay and no coinsurance for preventive and most comprehensive dental care. Medicare-covered dental services require no copay and a 20% coinsurance, while orthodontics are 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 drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copays, though prior authorization is required for these services. There is a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copay. There is a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, and while some services are covered, standard 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 (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance and requires prior authorization, with no prior 3-day hospital stay needed. There is no copay for days 1 to 20 and a $218 copay per day for days 21 to 100, though additional days beyond the 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 for eligible benefits, which include chronic illness meals, annual wellness exams, and a $30 monthly over-the-counter reimbursement. However, acupuncture is not covered under this plan.
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.
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