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Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual 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 Full Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 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 Full Dual 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 Full Dual 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 Full Dual 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 Full Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $5.80. 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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard retail pharmacies or standard mail-order services. For brand-name and specialized medications, cost-sharing is based on coinsurance rather than flat copays. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) offers robust medical coverage, featuring an inpatient hospital copay of $2,030 per admission and no coinsurance. For outpatient care, primary visits, and specialist services, members generally pay no copay alongside a 20% coinsurance. Emergency care requires a $115 copay, which is waived if admitted, while urgently needed services have a $40 copay. This plan also provides valuable supplemental benefits, including dental care with no copay or coinsurance for most services up to a $2,500 annual limit. Vision and hearing benefits feature no copays, offering up to $250 annually for eyewear and up to $1,500 per ear for prescription hearing aids. Additionally, members benefit from a $180 monthly over-the-counter allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $2,030 copayment per admission and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance, which includes outpatient hospital, ambulatory surgical center, observation, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services with no copay and a coinsurance of either 20% or 30%. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance, up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist, physical, occupational, and speech therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance. Podiatry and other healthcare professional services require no copay and 0% to 20% coinsurance, additional telehealth benefits have no copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) preventive services are partially covered, featuring no copay and no coinsurance for annual physicals and select supplemental benefits, alongside a 20% coinsurance and no copay for kidney education and other screenings. Not covered sub-services 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
Aetna Medicare Full Dual Care (HMO D-SNP) covers hearing services with no deductible, featuring 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 a $1,500 annual limit per ear, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductibles, featuring one annual routine eye exam with a 20% coinsurance and no copay, and other eye exams with no copay or coinsurance. Covered eyewear has a $250 annual limit, offering contact lenses with a 20% coinsurance and no copay, and eyeglasses with no copay or coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring no copay and no coinsurance for most preventive and comprehensive services up to a $2,500 annual maximum. Medicare-covered dental services require no copay and a 20% coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, although prior authorization is required for these services. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. There is no coinsurance for diagnostic radiological services, while a 20% coinsurance applies to diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, but only some services are covered. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers Other Services with no copay and no coinsurance for covered benefits, which include a $180 monthly over-the-counter reimbursement, chronic illness meal benefits, and select wellness exams and screenings. Acupuncture is not covered under this plan.
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