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Aetna Medicare Partial Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial 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 Partial Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 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 Partial 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 Partial 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 Partial 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 Partial Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.90. 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 $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 Partial Dual (HMO D-SNP) plan features an annual drug deductible of $615. For generic medications, this plan offers excellent cost savings with no copay for both Tier 1 Preferred Generic and Tier 2 Generic drugs. This $0 cost-sharing applies to one-month, two-month, and three-month supplies filled at standard retail pharmacies or through standard mail-order services. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 Preferred Brand drugs require a 22% coinsurance, while Tier 4 Non-Preferred Drugs and Tier 5 Specialty Tier drugs both carry a 25% coinsurance under standard pharmacy and mail-order options. These percentage-based costs apply to all available supply durations, helping you accurately estimate your out-of-pocket prescription expenses.
Additional Benefits
The Aetna Medicare Partial Dual (HMO D-SNP) plan covers essential medical services, featuring no copay and a 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Inpatient hospital stays require a copay of $2,100 for acute care or $2,080 for psychiatric care, while skilled nursing facility stays offer no copay for the first 20 days before transitioning to a $218 daily copay. Emergency room visits carry a $115 copay, which is waived if you are admitted within 24 hours. This plan also provides valuable supplemental coverage, including preventive and comprehensive dental services with no copay and no coinsurance. Vision and hearing benefits feature routine exams with a 20% coinsurance and no copay, alongside no-copay routine fitting evaluations and eyewear up to a $100 annual limit. Additionally, members benefit from no copays or coinsurance for home health services and select other perks like a chronic illness meal benefit and a $15 monthly over-the-counter reimbursement.
Inpatient Hospital See details
Aetna Medicare Partial Dual (HMO D-SNP) covers inpatient hospital services with a $2,100 copay per stay and no coinsurance for acute care, and a $2,080 copay per stay and no coinsurance for psychiatric care. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Partial 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 there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Partial Dual (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
Ambulance and Transportation Services are covered under the Aetna Medicare Partial Dual (HMO D-SNP) plan with a 20% coinsurance and no copay for ground and air ambulance services, which require prior authorization. While some transportation services are covered, transport to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted within 24 hours, and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are covered up to a $250,000 maximum with a $115 copay and no coinsurance, while worldwide emergency transportation has no copay.
Primary Care See details
Aetna Medicare Partial Dual (HMO D-SNP) offers primary care, specialist, mental health, and therapy services with no copay and a 20% coinsurance, while telehealth options feature no copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered under Aetna Medicare Partial Dual (HMO D-SNP), offering no copay and no coinsurance for annual physicals and most supplemental benefits, while kidney education and select screenings require a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP) with no deductible, featuring routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids have 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 Partial Dual (HMO D-SNP) covers vision services with no deductible, offering annual routine eye exams with no copay and 20% coinsurance. Eyewear is covered up to a $100 annual limit with no copay for frames, lenses, and upgrades, while contact lenses are covered with no copay and 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual (HMO D-SNP), with Medicare-covered dental requiring no copay and a 20% coinsurance. Preventive and comprehensive dental services are offered with no copay and no coinsurance, though orthodontic services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Partial Dual (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Partial Dual (HMO D-SNP) with no copays, though prior authorization is required. Beneficiaries will pay a 16% coinsurance for durable medical equipment, prosthetics, and medical supplies, a 20% coinsurance for diabetic therapeutic shoes or inserts, and no coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Aetna Medicare Partial Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays are subject to a 20% coinsurance, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Aetna Medicare Partial 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 Partial Dual (HMO D-SNP) covers some Cardiac Rehabilitation Services, although major sub-services are not covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Partial Dual (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Partial Dual (HMO D-SNP) plan, offering no copay and no coinsurance for covered benefits. Covered services include a chronic illness meal benefit, annual wellness exams, additional gFOBT and FIT screenings, and a $15 monthly over-the-counter reimbursement, while acupuncture is not covered.
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