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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare 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 Clark and Nye Counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 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 Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order, while standard options require a copay starting at $2. Tier 2 generic drugs are also highly affordable, with copays starting at $5 at preferred pharmacies and preferred mail order, compared to a $12 starting copay at standard locations. For brand-name and specialty medications, your costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance regardless of the pharmacy type or supply duration you choose. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan provides robust coverage with highly affordable out-of-pocket costs for essential medical needs. Beneficiaries benefit from no copays and no coinsurance for primary care doctor visits, routine dental cleanings, annual eye and hearing exams, and home health services. Additionally, the plan features generous allowances, including up to $150 annually for eyewear, a $1,000 annual limit per ear for prescription hearing aids, and a $40 monthly credit for over-the-counter items. For specialized care, inpatient hospital stays require a $100 daily copay for the first five days, followed by no copay for additional days. Outpatient hospital visits, specialist appointments, and diagnostic lab tests feature low copays and no coinsurance. While many services have no coinsurance, certain benefits like dialysis and medical equipment require a coinsurance of up to 20 percent.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $100 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, non-Medicare-covered stays, and upgrades for acute stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, featuring a copay of $0 to $100 for outpatient hospital services and $100 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ambulance services with prior authorization, requiring a $300 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services are not covered in practice, as trips to plan-approved and any health-related locations are both not covered.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Chronic Care (HMO C-SNP) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $20 copay and no coinsurance, while worldwide emergency and urgent services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Primary care physician services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, while specialist, therapy, and mental health services have copays ranging from no copay up to $25 and no coinsurance. Telehealth benefits are covered with a copay of $0 to $25 and 20% coinsurance, but chiropractic services are only partially covered since routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance for annual exams, health education, fitness, smoking cessation, remote access, and select screenings, while kidney disease education requires no copay and 20% coinsurance. Additional preventive services are partially covered, as the plan does not cover in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, 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, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), offering no copays, no coinsurance, and no deductibles for routine exams, fitting evaluations, and prescription hearing aids with a $1,000 maximum coverage limit per ear annually. However, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. This benefit includes one routine eye exam each year and a $150 annual maximum coverage limit toward contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered dental services, including cleanings and exams with no copay and no coinsurance, and Medicare-covered dental services for a $25 copay and no coinsurance. Comprehensive services are covered up to a $2,000 annual limit with no copay and 20% to 50% coinsurance, while fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, and diabetic supplies. Coinsurance ranges from 0% to 20% for DME and medical supplies, is 20% for prosthetic devices, and there is no coinsurance for diabetic equipment, with prior authorization required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required. Diagnostic procedures and lab services feature no coinsurance, with copays ranging from no copay to $20. Radiological services require copays starting at no copay, with X-rays carrying a $20 copay plus coinsurance, and therapeutic services requiring a minimum 20% coinsurance and a copay.
Home Health Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, though only some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), offering no copay and no coinsurance for over-the-counter (OTC) items up to $40 per month, annual wellness exams, screening mammography, and additional gFOBT and FIT. Acupuncture, meal benefits, and dual eligible SNP highly integrated services are not covered under this plan.
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