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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Metro: 5 boroughs of NYC. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services, while standard pharmacies charge a small copay starting at $2. Tier 2 generic drugs are also highly affordable, with copays starting at $5 at preferred locations and $12 at standard locations. For higher-tier medications, this plan transitions from flat copays to coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with Tier 5 coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many benefits. Members enjoy no copays for primary care visits, routine podiatry, and annual preventive exams, while specialist visits carry a copay of $0 to $50. Emergency care requires a $115 copay, which is waived if admitted, and inpatient hospital stays are covered with a daily copay of $407 for days 1 through 6 and no copay for days 7 through 90. This plan also includes valuable supplemental benefits to support overall well-being, such as home health services with no copay and no coinsurance. Dental care is covered with no copay or coinsurance for preventive and comprehensive services up to a $750 annual limit, and members receive up to $100 annually for eyewear alongside routine vision and hearing exams with no copays. Additionally, eligible members benefit from a $30 monthly over-the-counter reimbursement and chronic illness meal benefits with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $407 daily copay for days 1 through 6 (no copay for days 7 through 90) for acute stays and a $346 daily copay for days 1 through 6 (no copay for days 7 through 90) for psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Aetna Medicare Chronic Care (HMO C-SNP) are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $407 (including a $407 copay per stay for observation services), and outpatient substance abuse sessions have a $15 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, though prior authorization is required. Depending on the service, you will pay a copay of either $60.00 or $110.00.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground and air ambulance services with a $260 copay per service and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-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, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $260.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) provides primary care physician services and routine podiatry with no copay and no coinsurance, while specialist visits require a $0 to $50 copay and no coinsurance. Physical, occupational, and speech therapies incur a $35 copay with no coinsurance, whereas mental health, psychiatric, and opioid treatment services have a $40 copay and no coinsurance. Chiropractic services are not covered under this plan, and telehealth benefits carry a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides coverage for various preventive services, including annual physical exams, glaucoma screenings, and select wellness programs, with no copay and no coinsurance. This benefit is partially covered, as services such as in-home safety assessments, medical nutrition therapy, and weight management programs are not covered, and kidney disease education requires a 20% coinsurance with no copay.
Hearing Services See details
Hearing services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no deductible and no coinsurance, featuring a $50 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $0 to $1,700 for up to two aids per year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers vision services with no deductibles, offering eye exams with no coinsurance and copays ranging from $0 to $50, which includes one annual routine exam with no copay. Eyewear, including lenses, frames, and contact lenses, is also covered with no copay or coinsurance up to a combined maximum of $100 per year.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered dental services, featuring no copay and no coinsurance for preventive and most comprehensive care up to a $750 annual maximum. Medicare-covered dental services require a $50 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care (HMO C-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 and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Chronic Care (HMO C-SNP) with no copays, though prior authorization is required for these services. Durable medical equipment and medical supplies require a coinsurance between no coinsurance and 20% (20% for prosthetics), while diabetic equipment and shoes are fully covered with no copay and no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP), requiring prior authorization for all services. Diagnostic tests have no coinsurance and a $0 to $50 copay, lab services have no copay or coinsurance, and radiological services range from a $0 minimum copay for diagnostic imaging to a minimum 20% coinsurance for therapeutic radiology and a $50 copay with coinsurance for outpatient X-rays.
Home Health Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance. Although some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond standard Medicare coverage are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides partially covered other services, including acupuncture with a $50 copay and no coinsurance for up to 12 treatments per year. Eligible members also receive a $30 monthly over-the-counter reimbursement, chronic illness meal benefits, annual wellness exams, and select cancer screenings with no copay and no coinsurance, while certain other services are not covered.
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