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Aetna Medicare Advantra Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra 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 Advantra Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Dual Care (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra 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 Advantra 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 Advantra 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 Advantra Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.80. 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 Advantra Dual Care (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, members enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications when filled for one, two, or three months through standard pharmacies or standard mail order. This ensures affordable access to a wide range of essential everyday medications. For higher-tier medications, cost-sharing is structured as a percentage of the drug cost. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for one-month, two-month, or three-month supplies. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply at standard pharmacies or standard mail order.
Additional Benefits
The Aetna Medicare Advantra Dual Care (HMO D-SNP) offers comprehensive medical coverage, featuring inpatient hospital stays with fixed copayments and outpatient services with no copay and a 20% coinsurance. Primary care visits, specialist consultations, and diagnostic services generally require no copay and up to a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while urgently needed services have a $40 copay. This plan also includes valuable supplemental benefits, such as dental coverage up to $1,000 annually and a $300 yearly eyewear allowance, both featuring no copay for most routine services. You also receive hearing aid coverage up to $500 per ear annually and up to 24 one-way transportation trips per year with no copay or coinsurance. Additionally, members benefit from a $220 monthly over-the-counter allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers inpatient acute hospital stays with a $2,230 copayment per stay and psychiatric stays with a $2,080 copayment per stay, both with no coinsurance and requiring prior authorization. This benefit is partially covered as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance and prior authorization requirements apply to outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are also covered with no copay and a 20% coinsurance, with the deductible waived for the first three pints.
Partial Hospitalization See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on your coverage, you will pay either no copay and a 20% coinsurance, or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance, offering up to 24 one-way trips per year to plan-approved health-related locations via rideshare, public transit, or medical transport.
Emergency Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum lifetime limit.
Primary Care See details
Primary Care services under Aetna Medicare Advantra Dual Care (HMO D-SNP) are covered with no copay and 20% coinsurance, while specialist visits feature no copay and no coinsurance to 20% coinsurance. Therapy, mental health, psychiatric, and select podiatry services are covered with no copay and 20% coinsurance, but routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Advantra Dual Care (HMO D-SNP), featuring an annual physical with no copay and no coinsurance, while kidney disease education and glaucoma screenings have no copay and a 20% coinsurance. Many additional benefits have no copay and no coinsurance, but sub-services such as In-Home Safety Assessments, Medical Nutrition Therapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, and Counseling Services are not covered.
Hearing Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) provides partially covered hearing services with no deductible, including annual routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids, inner ear, outer ear, and over-the-ear prescription devices are not covered.
Vision Services See details
Vision services covered under the Aetna Medicare Advantra Dual Care (HMO D-SNP) plan include routine eye exams and contact lenses with no copay and a 20% coinsurance, alongside other eyewear like eyeglasses and frames with no copay. There is no deductible for these services, and the plan provides a combined maximum eyewear benefit of $300 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Dual Care (HMO D-SNP), offering up to $1,000 annually with no copay and no coinsurance for most preventive and comprehensive services, while Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aetna Medicare Advantra Dual Care (HMO D-SNP) plan with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance, requiring prior authorization.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra Dual Care (HMO D-SNP), featuring no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers diagnostic and radiological services with no copay, though a 20% coinsurance and prior authorization are required. This coverage includes diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered by Aetna Medicare Advantra Dual Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the Medicare limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Advantra Dual Care (HMO D-SNP) with no copay and no coinsurance for eligible benefits, which include a $220 monthly over-the-counter allowance, chronic illness meals, and select wellness exams. Acupuncture is not covered under this plan.
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