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Aetna Community HealthChoices (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Community HealthChoices (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 Community HealthChoices (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Community HealthChoices (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northwestern Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Community HealthChoices (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 Community HealthChoices (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 Community HealthChoices (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 Community HealthChoices (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.70. 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 Community HealthChoices (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month, two-month, or three-month supplies at standard pharmacies and standard mail order. For higher-tier medications, cost sharing is determined by coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for up to a three-month supply. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Community HealthChoices (HMO D-SNP) plan offers comprehensive coverage with many services featuring no copayments, though some care requires coinsurance or specific copays. For instance, primary care, preventive visits, and home health services require no copay or coinsurance, while emergency room visits carry a $115 copay and urgent care costs $40. Inpatient acute hospital stays require a $2,210 copay per admission with no coinsurance, whereas outpatient hospital services and diagnostic tests generally have no copay but require a 20% coinsurance. This plan also includes valuable supplemental benefits, such as dental and vision care, which feature no copays and generous annual limits. Preventive and comprehensive dental services are covered with no copay or coinsurance up to a $1,500 yearly limit, and prescription hearing aids are covered up to $1,500 per ear each year. Additionally, members benefit from up to 24 free one-way transportation trips annually and a monthly allowance of up to $250 for over-the-counter items.
Inpatient Hospital See details
Aetna Community HealthChoices (HMO D-SNP) partially covers inpatient hospital services, requiring prior authorization and no coinsurance for covered stays. Acute inpatient stays require a $2,210 copayment per admission, and psychiatric stays require a $2,080 copayment per admission, but additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay, although a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient benefits, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Community HealthChoices (HMO D-SNP) with prior authorization required. Cost-sharing for this benefit is either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Community HealthChoices (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 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
Emergency services are covered by Aetna Community HealthChoices (HMO D-SNP) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum benefit with no copay and no coinsurance.
Primary Care See details
Aetna Community HealthChoices (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and coinsurance ranging from no coinsurance up to 20%, though telehealth services may carry a copay of up to $40. For chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the Aetna Community HealthChoices (HMO D-SNP) plan, offering no copay and no coinsurance for annual physical exams and select supplemental benefits, while kidney disease education and other specific screenings require no copay and a 20% coinsurance. Non-covered sub-services include In-Home Safety Assessment, 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 Benefit, 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 Community HealthChoices (HMO D-SNP) offers hearing services with no deductible, including one annual routine hearing exam with no copay and a 20% coinsurance, and one annual fitting evaluation with no copay or coinsurance. Prescription hearing aids are covered up to $1,500 per ear every year with no copay or coinsurance, but the benefit is partially covered as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Community HealthChoices (HMO D-SNP) covers vision services with no deductibles, featuring annual routine and follow-up diabetic eye exams with no copays, though routine exams are subject to a 20% coinsurance. Covered eyewear has a $300 annual limit with no copays, requiring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses.
Dental Services See details
Dental services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other preventive and comprehensive dental services up to a $1,500 yearly limit. This benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and no coinsurance, though prior authorization and step therapy are required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Community HealthChoices (HMO D-SNP), with prior authorization required for most items. Covered durable medical equipment, prosthetics, and medical supplies feature no copay and a 20% coinsurance, while diabetic supplies have no copay and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Community HealthChoices (HMO D-SNP) covers diagnostic and radiological services, including lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, with no copay and a 20% coinsurance. Prior authorization is required for all of these covered services.
Home Health Services See details
Home Health Services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay, but some services are covered while others are not covered in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Community HealthChoices (HMO D-SNP) with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay applies for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Community HealthChoices (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a chronic illness meal benefit, annual wellness exams, additional gFOBT and FIT screenings, and up to $250 monthly for over-the-counter items via reimbursement. Acupuncture is not covered under this plan.
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