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Aetna Medicare Assure (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure (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 Assure (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure (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 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure (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 Assure (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 Assure (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 Assure (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $33.80. 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 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs depending on the drug tier and pharmacy used. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly premium of $33.80.
Additional Benefits
The Aetna Medicare Assure (HMO-POS D-SNP) plan offers a range of benefits, including inpatient and outpatient services, with varying copays and coinsurance. For example, you'll pay a $2110 copay for inpatient hospital stays, while outpatient and partial hospitalization services have a 20% coinsurance. Emergency and preventive services, such as an annual physical exam, have no copay. This plan also includes coverage for hearing, vision, and dental services, with some services having no copay. Hearing exams have a 20% coinsurance, with prescription hearing aids covered up to $1250 per year. Vision services include eye exams and eyewear, with eye exams at 20% coinsurance and no copay for routine eye exams. The plan also offers a $2,000 maximum benefit for dental services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Inpatient Hospital-Acute has a copay of $2110 per admission or stay, and the plan covers unlimited additional days with no copay. However, the plan does not cover Non-Medicare-covered Stay or Upgrades for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a copay of $2036 per admission or stay, and the plan does not cover additional days or Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, and all other services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Assure (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Assure (HMO-POS D-SNP) plan. Ground and Air Ambulance Services have a 20% coinsurance, and there is no copay. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Assure (HMO-POS 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
Primary Care benefits include coverage for Primary Care Physician Services with a 14% coinsurance, Chiropractic Services with a 20% coinsurance (excluding routine care), Occupational Therapy Services with a 20% coinsurance, Physician Specialist Services with a 0-20% coinsurance, Mental Health Specialty Services with a 20% coinsurance, Other Health Care Professional services with a 0-20% coinsurance, Psychiatric Services with a 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with a 20% coinsurance, and Opioid Treatment Program Services with a 20% coinsurance. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional preventive services, including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications, are covered with a copay.
Hearing Services See details
Hearing exams are covered with a 20% coinsurance for routine hearing exams, and a $0 copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a $0 copay, up to a maximum of $1250 per year. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and Routine Eye Exams and Other Eye Exam Services have no copay. Eyewear has a 20% coinsurance, and Contact Lenses, Eyeglasses (lenses and frames), Eyeglass lenses, Eyeglass frames, and Upgrades have no copay. There is a $400 combined maximum plan benefit for all eyewear per year.
Dental Services See details
Dental services include Medicare dental services with 20% coinsurance and other dental services with a $2,000 maximum benefit per year, including 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), and oral and maxillofacial surgery with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Assure (HMO-POS D-SNP). Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a coinsurance that may be at most 20% for Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Radiological Services have a coinsurance that may be at most 20%, but with a minimum of 0%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure (HMO-POS D-SNP) plan with no copay and no coinsurance; however, 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 (HMO-POS D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Aetna Medicare Assure (HMO-POS D-SNP) plan covers over-the-counter items with no copay and a maximum benefit of $60.00 per month. This plan also covers meal benefits with no copay, and annual wellness exams, screening mammography, and gFOBT/FIT tests with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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