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Aetna Medicare Assure QMB (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure QMB (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 QMB (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure QMB (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 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure QMB (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 QMB (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 QMB (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 QMB (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.60. 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 QMB (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS) program, your monthly premium for Part D will be $57.60.
Additional Benefits
The Aetna Medicare Assure QMB (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services, partial hospitalization, ambulance services, and many primary care services have a 20% coinsurance. Emergency services have a copay, while preventive services like annual physical exams are covered with no copay. The plan includes coverage for hearing, vision, and dental services, with specific copays or coinsurance amounts depending on the service. Additionally, it covers home health services, dialysis, and medical equipment with coinsurance. Other benefits such as over-the-counter items and meal benefits are covered with no copay. Notably, cardiac rehabilitation services and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2,185, with additional days having no copay; Inpatient Hospital Psychiatric services have a $2,036 copay for a Medicare-covered stay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, Ambulatory Surgical Center (ASC) services, and outpatient substance abuse services, are covered with a 20% coinsurance. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Assure QMB (HMO D-SNP) plan, but requires prior authorization. You will be responsible for a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Assure QMB (HMO D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. 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 QMB (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure QMB (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. For most services, you will pay 20% coinsurance, and there is no copay for additional telehealth benefits. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy have no copay, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams have no copay and a 20% coinsurance, with 1 exam covered every year. Fitting/evaluation for hearing aids has no copay and 1 visit covered every year. Prescription hearing aids (all types) have a maximum copay of $1,700, with 2 covered every year, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a 20% coinsurance, and routine and other eye exam services with no copay. Eyewear is partially covered, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with 20% coinsurance for Medicare dental services. 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 are covered with no copay, while orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Aetna Medicare Assure QMB (HMO D-SNP) plan. There is a coinsurance of 20% for these services, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Assure QMB (HMO D-SNP) plan, with a 20% coinsurance for durable medical equipment, prosthetic devices, and 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 are covered under the Aetna Medicare Assure QMB (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Assure QMB (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 not covered by the Aetna Medicare Assure QMB (HMO D-SNP) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the cost sharing details are not provided. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits with no copay, and Other 1 and Other 2 services with no copay; however, acupuncture and several other services are not covered. Over-the-Counter (OTC) Items have a maximum plan benefit coverage amount of $15.00 per month.
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