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Aetna Medicare Full Dual (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (HMO-POS 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-POS D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maine. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual (HMO-POS 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-POS 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-POS 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-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.20. 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
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 Full Dual (HMO-POS D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a $10 copay for a one-month supply, a $20 copay for a two-month supply, and a $30 copay for a three-month supply. For brand-name and specialty medications, costs are based on coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual (HMO-POS D-SNP) plan offers comprehensive coverage with many essential services requiring no copay, though some medical care is subject to a 20% coinsurance. For everyday healthcare, beneficiaries pay no copay for primary care, telehealth, preventive care, and home health services, while specialist visits, diagnostics, and outpatient services carry a 20% coinsurance. Inpatient hospital stays require a $1,830 copay per admission, whereas emergency room visits have a $115 copay that is waived if admitted. This plan also includes valuable supplemental benefits to help reduce personal health expenses. Dental, vision, and hearing services feature no copays, including up to $1,000 annually for dental care, a $425 eyewear allowance, and up to $1,250 per ear for prescription hearing aids. Members also receive a $150 monthly over-the-counter allowance and fully covered skilled nursing facility care with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,830 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not included.
Outpatient Services See details
Aetna Medicare Full Dual (HMO-POS 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 Full Dual (HMO-POS D-SNP) covers partial hospitalization services with prior authorization, requiring 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-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Full Dual (HMO-POS D-SNP) with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Primary Care benefits under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan feature no copay for covered services, including primary care, specialists, therapies, and mental health, though most of these services require a 20% coinsurance (0% to 20% for specialists and other professionals). Telehealth services are fully covered with no copay and no coinsurance, whereas chiropractic services (including routine and other care) and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan, featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney education and other screenings carry no copay and a 20% coinsurance. Sub-services that are not covered include 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.
Hearing Services See details
Hearing Services under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan are partially covered, offering one routine hearing exam per year with a 20% coinsurance and no copay, and one fitting evaluation with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, though OTC hearing aids, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual (HMO-POS D-SNP) with no deductibles, offering one routine eye exam per year with no copay and a 20% coinsurance, alongside follow-up diabetic exams with no copay. Covered eyewear has no copay, but contact lenses require a 20% coinsurance, all subject to a combined maximum plan benefit of $425 per year.
Dental Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) provides partially covered dental services with no copay and no coinsurance for preventive and comprehensive care up to a $1,000 annual limit, while Medicare-covered dental services require a 20% coinsurance and no copay. Implant services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
The Aetna Medicare Full Dual (HMO-POS D-SNP) plan covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Medical Equipment See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers diagnostic and radiological services with no copays, although prior authorization is required. A 20% coinsurance applies to lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan, as key programs including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. While there is no copay for these services, they require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are partially covered by Aetna Medicare Full Dual (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization is required. Standard Medicare-defined days are covered without requiring a prior three-day hospital stay, but 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-POS D-SNP) with no copay and no coinsurance, offering benefits like a $150 monthly over-the-counter allowance, chronic illness meals, and select wellness screenings. Acupuncture is not covered under this plan benefit.
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