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Aetna Medicare Dual Extra Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra Care (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 Dual Extra Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra Care (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 Dual Extra Care (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 Dual Extra Care (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 Dual Extra Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.80. 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 $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 Dual Extra Care (HMO D-SNP) prescription drug coverage includes an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, the plan offers no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. This ensures that essential generic prescriptions remain highly accessible and affordable for members. For brand-name and specialty medications, costs are structured as coinsurance at standard pharmacies and standard mail-order services. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply to up to three-month supplies, with the exception of Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) offers comprehensive medical coverage with no deductible on most services, though cost-sharing applies depending on the care received. Inpatient hospital stays require a $2,000 copay per admission with no coinsurance, while outpatient services, primary care, and specialist visits feature no copay and generally require a 20% coinsurance. Emergency room visits have a $115 copay, which is waived upon admission, while urgent care visits carry a $40 copay. This plan also provides robust supplemental benefits, including preventive dental care up to a $2,000 annual limit with no copay, and a $250 annual allowance for eyewear with no copay or coinsurance. Hearing care features a $1,500 annual allowance per ear for prescription hearing aids with no copay or coinsurance, alongside a $130 monthly allowance for over-the-counter items. Skilled nursing facility care is covered with no coinsurance, requiring no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,000 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization are required for most benefits. This includes outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and outpatient blood services which feature no deductible.
Partial Hospitalization See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization services with no copay and a 20% or 30% coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Routine transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Dual Extra Care (HMO 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, and urgent care with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care, specialist, therapy, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while telehealth benefits are available with no copay and no coinsurance. Routine podiatry is covered for up to 12 visits per year with no copay and up to 20% coinsurance, but chiropractic services are not covered in practice as all sub-services are excluded.
Preventive Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) provides partially covered preventive services, featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney disease education and specific screenings require a 20% coinsurance and no copay. Sub-services not covered under this plan 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 are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, featuring one routine hearing exam per year with a 20% coinsurance and no copay, alongside one fitting evaluation with no copay. Prescription hearing aids are covered up to $1,500 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers vision services with no deductible, including one annual routine eye exam with no copay and 20% coinsurance, and unlimited diabetic eye exams with no copay or coinsurance. Eyewear is covered up to a $250 annual maximum with no copay and no coinsurance, except for contact lenses which require a 20% coinsurance and no copay.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), offering up to a $2,000 annual maximum for non-Medicare dental care. Medicare-covered dental services have no copay and a 20% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are 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 feature no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Diagnostic radiological services have no coinsurance, while outpatient diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) provides Cardiac Rehabilitation Services with no copay, but some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers Other Services with no copay and no coinsurance for covered benefits, including a $130 monthly over-the-counter allowance, chronic illness meal benefits, and annual wellness exams. Acupuncture is not covered under this plan.
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