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Aetna Medicare Assure Premier 1 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Premier 1 (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 Assure Premier 1 (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Premier 1 (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 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Premier 1 (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 Assure Premier 1 (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 Assure Premier 1 (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 Assure Premier 1 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.80. 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:
Sign up for Aetna Medicare Assure Premier 1 (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Assure Premier 1 (HMO D-SNP) plan has a deductible of $590.00. After you meet the deductible, you will pay the costs for your drugs, but the specific amounts are not listed. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $20.80.
Additional Benefits
The Aetna Medicare Assure Premier 1 (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay per admission, while outpatient services, including mental health and substance abuse, generally have a 20% coinsurance. Emergency and urgent care services have a copay, but worldwide emergency services have no copay. This plan provides coverage for primary care, preventive services, and several specialist services, often with coinsurance. It also includes coverage for hearing, vision, and dental services with varying coinsurance and copays, and offers additional benefits like transportation services, home health, and medical equipment. The plan also offers over-the-counter benefits and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay of $2100 per admission for Acute and $2036 per admission for Psychiatric stays. Additional days for Acute inpatient hospital stays are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, individual and group sessions for outpatient substance abuse, and outpatient blood services, are covered. Outpatient Hospital Services, Observation Services, Individual Sessions for Outpatient Substance Abuse and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance. Outpatient Blood Services also have a 20% coinsurance, but with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, with up to 24 one-way trips per year via rideshare, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Assure Premier 1 (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Under the Aetna Medicare Assure Premier 1 (HMO D-SNP) plan, Primary Care includes coverage for Primary Care Physician Services, with a 20% coinsurance. Chiropractic Services are partially covered, and Routine Chiropractic Care is not covered. Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Podiatry Services are covered, including routine foot care, with a 20% coinsurance. Other Health Care Professional services are covered with a coinsurance between 0% and 20%. Additional Telehealth Benefits are covered with no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services have a copay, and some services, such as in-home safety assessments, are not covered. Other services, such as kidney disease education services, glaucoma screening, and diabetes self-management training, have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids are covered with no copay and a maximum plan benefit coverage of $2000 per year for all types. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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 for routine eye exams, and no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, up to a combined maximum of $400 per year.
Dental Services See details
The Aetna Medicare Assure Premier 1 (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment are covered with no copay, and there is a $3,500 maximum benefit per year for other dental services. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have visit limitations. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Assure Premier 1 (HMO D-SNP) plan. This plan requires prior authorization and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Assure Premier 1 (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices and Medical Supplies have a 20% coinsurance. 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 under the Aetna Medicare Assure Premier 1 (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have no coinsurance, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Premier 1 (HMO 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 generally covered, but not in practice. 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 are not covered. Prior authorization is required, and the copay is determined by Medicare-defined cost sharing for tier 1.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and a maximum of $155.00 per month for OTC items. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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