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Aetna Medicare Partial Dual (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial 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 Partial Dual (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial 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 Partial 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 Partial 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 Partial 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 Partial Dual (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.70. 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 Partial Dual (HMO-POS D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay for one-month, two-month, and three-month supplies at standard pharmacies and 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 higher-tier medications, cost-sharing transitions to a coinsurance percentage. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Specialty tier medications are limited to a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Aetna Medicare Partial Dual (HMO-POS D-SNP) plan offers comprehensive medical coverage, featuring no copays for primary care, outpatient services, and home health care, though a 20% coinsurance typically applies to doctor visits and outpatient procedures. Inpatient hospital stays require a copay of $2,120 for acute care and $2,080 for psychiatric care per stay, with no coinsurance. Additionally, emergency room visits carry a $115 copay, which is waived if you are admitted, while urgent care services require a $40 copay. For supplemental health needs, the plan provides dental coverage up to $1,000 annually and hearing aid coverage up to $1,250 per ear with no copay or coinsurance. Vision benefits feature no copays for routine annual exams and up to $225 yearly for eyewear, though routine exams and contacts carry a 20% coinsurance. Members also benefit from no copays or coinsurance on skilled nursing facility stays, home health care, and up to $25 monthly for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) partially covers inpatient hospital services, featuring no coinsurance but requiring a $2,120 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Partial 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 services, and there is no deductible for outpatient blood services, with the cost waived for the first three pints.
Partial Hospitalization See details
The Aetna Medicare Partial Dual (HMO-POS D-SNP) plan covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, which requires prior authorization and is not waived upon hospital admission. While transportation benefits are technically offered, only some services are covered, and transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are 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 limit.
Primary Care See details
Primary care benefits under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan are covered with no copay and a 20% coinsurance (0% to 20% for specialists), while telehealth services have no copay and no coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) provides partially covered preventive services, including annual physical exams and select supplemental benefits with no copay and no coinsurance. While services like health education and fitness are covered, other sub-services such as medical nutrition therapy, weight management, and alternative therapies are not covered. Kidney disease education and other specific screenings are covered with no copay and 20% coinsurance.
Hearing Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,250 per ear annually, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers vision services with no deductible, offering annual routine eye exams and follow-up diabetic exams with no copays, though routine exams carry a 20% coinsurance. Covered eyewear, including contact lenses and eyeglasses, has no copays up to a $225 yearly limit, with a 20% coinsurance applying only to contact lenses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual (HMO-POS D-SNP), featuring a $1,000 annual limit with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copays, though prior authorization is required. Members pay a 20% coinsurance for lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay, although some services are not covered in practice. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered by the plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Partial Dual (HMO-POS D-SNP), offering no copay and no coinsurance for OTC items up to $25 monthly, chronic illness meals, annual wellness exams, and additional gFOBT and FIT screenings. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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