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Aetna Medicare Advantra Cares (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Cares (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 Advantra Cares (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Cares (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeastern Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Cares (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 Advantra Cares (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 Advantra Cares (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 Advantra Cares (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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:
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Drug Coverage
The Aetna Medicare Advantra Cares (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy, your Part D premium will be $36.20. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Advantra Cares (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay per admission, while outpatient services, including some blood services, have a 20% coinsurance. Emergency services have copays, and transportation to plan-approved health-related locations is covered up to 12 one-way trips per year with no copay. Preventive services like annual physical exams and additional services like health education have no copay. Hearing exams, hearing aids, and dental services have a coinsurance with maximum annual benefits. Vision services include eye exams and eyewear with a coinsurance, and some have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Advantra Cares (HMO D-SNP) plan, with a copay of $2185 per admission or stay for Inpatient Hospital-Acute, and a copay of $2036 per admission or stay for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, and Outpatient Blood Services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered, with a 20% coinsurance for both. Transportation services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Advantra Cares (HMO D-SNP) plan covers Primary Care Physician Services with a 17% coinsurance. Chiropractic Services are covered with a 20% coinsurance, but routine chiropractic care is not covered. Occupational Therapy Services and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Physician Specialist Services are covered with a 0% to 20% coinsurance. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance for individual and group sessions. Podiatry Services are covered with a 20% coinsurance for routine foot care and no copay for Medicare-covered podiatry services. Other Health Care Professional services are covered with a 0% to 20% coinsurance. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0.00 and $45.00.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, all with a $0 copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay and a 20% coinsurance, and prescription hearing aids have no copay and a maximum plan benefit of $500 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, with routine eye exams and other eye exam services having no copay. Eyewear has a 20% coinsurance, with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades having no copay; this benefit has a combined maximum of $500 per year.
Dental Services See details
The Aetna Medicare Advantra Cares (HMO D-SNP) plan covers dental services with a 20% coinsurance and a maximum benefit of $2,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but some have visit limits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. The cost for Medicare Part B Insulin Drugs is a $35 copay, while 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 Advantra Cares (HMO D-SNP) plan. The plan requires prior authorization and has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Equipment is covered, including Diabetic Supplies with no copay and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. You will pay no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% 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 Advantra Cares (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and you will have a copay.
Other Services See details
The Aetna Medicare Advantra Cares (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. The plan does not cover 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.
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