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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 Kent, New Castle, Sussex counties. 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 $23.90. 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. Once you meet your deductible, you will pay the costs for your drugs, which depend on the specific tier and pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. Your monthly premium for Part D is $23.90.
Additional Benefits
The Aetna Medicare Advantra Cares (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Hospital stays have a $1,930 copay, while outpatient services, partial hospitalization, and many primary care services have a 20% coinsurance. Emergency and urgently needed services have copays of $110 and $45, respectively. This plan also includes coverage for preventive services, hearing, vision, and dental. Hearing exams, vision exams, and dental services have a coinsurance of up to 20%, with some services like routine eye exams and dental cleanings having no copay. The plan also covers home health, medical equipment, and dialysis services with a coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $1,930 per admission or stay. 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 all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered by this plan. Outpatient hospital services, observation services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for transportation services. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are limited to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance, while Physician Specialist Services have a 0%-20% coinsurance. Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance for individual and group sessions. Podiatry services offer Routine Foot Care with a 20% coinsurance and no copay for Medicare-covered services. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with a copay that varies by service. Kidney disease education and other preventive services, such as glaucoma screenings, have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and a fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per year. Prescription hearing aids (all types) have no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with 20% coinsurance for routine eye exams, and no copay for routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Aetna Medicare Advantra Cares (HMO D-SNP) plan covers dental services with a 20% coinsurance, and has a $2,000 annual maximum. Oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventative dental services are covered with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, the copay is $35.00. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan, with a coinsurance of 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance with no copay, and Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan, with no copay for all services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, and Diagnostic Radiological Services have a coinsurance of at most 0%, while 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
Aetna Medicare Advantra Cares (HMO D-SNP) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan does cover some Cardiac and Pulmonary Rehabilitation Services with coinsurance, but more details are needed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Cares (HMO D-SNP) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay is the same as the Medicare-defined cost share for tier 1.
Other Services See details
Under "Other Services", acupuncture, 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 are not covered. Over-the-counter (OTC) items and meal benefits have no copay, while other services include annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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