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Aetna Medicare Advantra Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Dual (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central and Western 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 (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.80. 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 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month, two-month, or three-month supplies filled at a standard pharmacy or through standard mail order. For higher-tier medications, costs are based on coinsurance rather than flat copayments during the initial coverage phase. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty tier drugs carry a 25% coinsurance for standard pharmacy and mail order services.
Additional Benefits
The Aetna Medicare Advantra Dual (HMO D-SNP) plan offers robust medical coverage, featuring inpatient hospital stays with a $2,230 copayment for acute care and a $2,080 copayment for psychiatric care, both with no coinsurance. Most outpatient care, doctor visits, diagnostic tests, and medical equipment are covered with no copay and a 20% coinsurance. Emergency room visits require a $115 copay, which is waived if admitted, while urgent care services carry a $40 copay with no coinsurance. Additionally, the plan provides valuable supplemental benefits, including up to $2,500 annually for preventive and comprehensive dental care with no copay or coinsurance. Vision and hearing benefits feature no copay, offering up to $450 yearly for eyewear and up to $500 per ear for prescription hearing aids. Members also benefit from no copay on home health services, up to 24 one-way transportation trips, and a $245 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Advantra Dual (HMO D-SNP) partially covers inpatient hospital services, as additional days, upgrades, and non-Medicare-covered stays are not covered. Medicare-covered acute stays require a $2,230 copayment per stay and psychiatric stays require a $2,080 copayment per stay, both with no coinsurance and requiring prior authorization.
Outpatient Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will either pay a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Dual (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 and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, with no coinsurance for either service. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and coinsurance ranging from no coinsurance to 20%, though chiropractic services are not covered in practice. Additional telehealth services are available with no copay to a $40 copay and 20% coinsurance, while routine podiatry is covered for up to six visits per year with 20% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Advantra Dual (HMO D-SNP), offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and specific screenings require no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, and counseling services.
Hearing Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers annual 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 $500 per ear annually, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services covered under the Aetna Medicare Advantra Dual (HMO D-SNP) plan include one routine eye exam per year and contact lenses with no copay and 20% coinsurance. Eyeglasses, frames, lenses, and upgrades are covered with no copay and no coinsurance, up to a combined maximum benefit of $450 per year with no deductible.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Advantra Dual (HMO D-SNP), offering up to $2,500 annually with no copay and no coinsurance for most preventive and comprehensive dental care. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra Dual (HMO D-SNP) with 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 require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Advantra Dual (HMO D-SNP) with no copay and a 20% coinsurance, subject to prior authorization. This coverage applies to outpatient diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-rays.
Home Health Services See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Aetna Medicare Advantra Dual (HMO D-SNP) have no copay, but only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient 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
Other services are partially covered by Aetna Medicare Advantra Dual (HMO D-SNP) with no copay and no coinsurance, including chronic illness meal benefits, wellness exams, and up to $245 monthly for over-the-counter items. Acupuncture is not covered under this plan.
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