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Aetna Medicare Prime Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Maricopa County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6750.00 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 Prime Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. If you qualify for the Low-Income Subsidy, also known as Extra Help, you will pay no premium for your Medicare Part D coverage. Once your deductible is met, you will pay copayments or coinsurance depending on your prescription's drug tier. For Tier 1 preferred generic drugs, you will pay a $5.00 copay at preferred pharmacies and mail services, or a $12.00 copay at standard pharmacies. Tier 2 standard generic drugs require a 22% coinsurance, while Tier 3 preferred brands and Tier 4 non-preferred drugs both require a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits and low copays ranging from no copay to $20 for specialist visits. For inpatient hospital stays, members pay a daily copay of $325 for days one through six, with no copay or coinsurance for days seven through 90. Outpatient services are highly affordable, featuring no coinsurance and no copay for ambulatory surgical centers. This plan also includes valuable supplemental benefits, providing routine vision, hearing, and preventive dental care with no copays, no deductibles, and no coinsurance. Members receive up to a $150 annual eyewear allowance, up to $1,000 per ear annually for prescription hearing aids, and a $20 monthly allowance for over-the-counter items. Additionally, diabetic supplies and home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) offers partially covered inpatient hospital acute and psychiatric services with a $325 daily copay for days 1 through 6 and no copay or coinsurance for days 7 through 90. Prior authorization is required, and specific sub-services such as additional days, non-Medicare-covered stays, and upgrades for acute care are not covered.
Outpatient Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient substance abuse sessions require a $20 copay, while outpatient hospital and observation services incur a copay of $0 to $325.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with a copay of $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), with ground ambulance services requiring a $300 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency care is covered up to a $250,000 limit with copays between $130 and $300 and no coinsurance.
Primary Care See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers primary care visits with no copay and specialist visits with a copay ranging from no copay to $20, both with no coinsurance. Therapy and mental health services require a $20 copay and no coinsurance, telehealth involves a 20% coinsurance and up to a $50 copay, and chiropractic services are only partially covered since routine chiropractic care is excluded.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), featuring no copays and no coinsurance for annual physicals, health education, and routine screenings. While kidney disease education requires a 20% coinsurance with no copay, several supplemental benefits such as alternative therapies, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), offering no copay, no deductible, and no coinsurance for routine exams, fitting evaluations, and general prescription hearing aids up to a $1,000 annual limit per ear. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered under this benefit.
Vision Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers vision services with no copay, no coinsurance, and no deductible. Members are covered for one routine eye exam per year, unlimited follow-up diabetic eye exams, and up to a $150 annual allowance for eyewear, including contact lenses, eyeglasses, and upgrades.
Dental Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) partially covers dental services, offering preventive care like oral exams, cleanings, and x-rays with no copay and no coinsurance. Medicare-covered dental services have a $20 copay and no coinsurance, while covered orthodontic services have no copay and 20% to 50% coinsurance up to a $1,500 annual limit. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers home infusion bundled services with prior authorization, requiring a $35 copay for Medicare Part B insulin. Chemotherapy, radiation, and other Part B drugs feature cost sharing ranging from no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan with a 20% coinsurance and no copay. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under Aetna Medicare Prime Chronic Care (HMO C-SNP) with prior authorization required. Durable medical equipment and medical supplies feature no copay and range from no coinsurance to 20% coinsurance, while prosthetic devices have no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with prior authorization, featuring no copay for lab services and no coinsurance for most diagnostic procedures. Outpatient X-rays require a $20 copay, diagnostic tests range from no copay to $20, diagnostic radiology costs up to a $150 copay, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are not covered in practice under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. Although the plan indicates some services are covered, sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, leaving members with no copay or coinsurance coverage for these treatments.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100 with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance for annual wellness exams, screening mammographies, additional colorectal cancer screenings, and up to $20 monthly in over-the-counter items. Acupuncture, meal benefits, and highly integrated services for dual eligible SNPs are not covered under this plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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