A non-government entity
Aetna Medicare Partial Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial Dual Care (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 Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Metro Area: LI, 5 Boroughs, Westchester/Rockland. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Partial Dual Care (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 Care (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 Care (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 Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.30. 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:
Sign up for Aetna Medicare Partial Dual Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Partial Dual Care (HMO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This zero-dollar cost sharing applies to one-month, two-month, and three-month supplies of these generic medications. For brand-name and specialty medications, members pay a percentage of the drug cost through coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Medicare Partial Dual Care (HMO D-SNP) offers robust medical coverage, featuring a $2,060 copay per admission for inpatient hospital stays with no coinsurance. For outpatient services, doctor visits, and specialist consultations, members generally pay no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, while telehealth services are fully covered with no copay and no coinsurance. Routine preventive and comprehensive dental services are covered with no copay and no coinsurance, while routine vision and hearing exams require a 20% coinsurance and no copay. Skilled nursing facility stays feature no copay and no coinsurance for the first 20 days, followed by a $218 copay per day for days 21 through 100. Additionally, durable medical equipment is covered with a 16% coinsurance and no copay, and home health services are available with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,060 copay per admission and no coinsurance, requiring prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and a 20% coinsurance for outpatient hospital care, ambulatory surgical centers, outpatient substance abuse sessions, and outpatient blood services. 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
Partial hospitalization is covered by Aetna Medicare Partial Dual Care (HMO D-SNP) and requires prior authorization. Depending on the service, your costs will be either no copay with 20% coinsurance, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered up to a $250,000 maximum benefit with a $115 copay and no coinsurance, while worldwide emergency transportation is provided with no copay or coinsurance.
Primary Care See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers primary care, specialist visits, occupational and physical therapies, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Telehealth services are fully covered with no copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, health education, and fitness benefits, while kidney education and screenings require no copay and 20% coinsurance. However, sub-services including In-Home Safety Assessments, Medical Nutrition Therapy, post-discharge medication reconciliation, re-admission 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 are not covered.
Hearing Services See details
Hearing services covered by Aetna Medicare Partial Dual Care (HMO D-SNP) include one routine exam per year with a 20% coinsurance and no copay, and one annual fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $0 to $1,700 for up to two aids yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered. There is no deductible for these services.
Vision Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers vision services with no deductibles, offering routine eye exams and eyewear with no copays, though a 20% coinsurance applies to routine exams and contact lenses. The plan includes one routine eye exam per year and provides a combined maximum benefit of $100 annually for eyewear, including eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), with orthodontic services not covered. Medicare-covered dental services require no copay and a 20% coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and no coinsurance, as Part D home infusion drugs are not covered under the bundle. Prior authorization and step therapy are required, with Medicare Part B insulin carrying a $35 copay and no coinsurance, and chemotherapy and other Part B drugs requiring no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Medical Equipment See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, and medical supplies carry a 16% coinsurance, while diabetic supplies have no coinsurance and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with prior authorization required and no copays. Members pay 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 Partial Dual Care (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 Care (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a meal benefit for chronic illness, annual wellness exams, and up to $15 monthly in over-the-counter item reimbursements. Acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved