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Aetna Medicare Community Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Community Complete (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 Community Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Community Complete (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 Community Complete (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 Community Complete (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 Community Complete (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 Community Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.80. 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 $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 Community Complete (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs according to the plan's formulary, until your total drug costs reach $2000.00. Once you reach this amount, you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium will be $36.80. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Community Complete (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a high copay per admission, while outpatient services and many therapies have a 20% coinsurance. Emergency services have a copay, but transportation to health-related locations, preventive services, and hearing exams have no copay. This plan also includes benefits for vision, dental, and home health services. Dental and vision services have a 20% coinsurance, and the plan offers coverage for eyewear and hearing aids. The plan also provides coverage for home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For a Medicare-covered stay, the copay is $2,185 per admission or stay for Inpatient Hospital-Acute and $2,036 per admission or stay for Inpatient Hospital Psychiatric; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital and Observation Services have a 20% coinsurance. Ambulatory Surgical Center Services and Outpatient Substance Abuse Services have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Community Complete (HMO D-SNP) plan, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Community Complete (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation services to plan-approved health-related locations have no copay.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Community Complete (HMO D-SNP) plan, with a $110 copay, and no coinsurance. Urgently needed services have a $45 copay, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay, and no coinsurance, with a maximum benefit of $50,000.
Primary Care See details
Primary Care Physician Services are covered with 17% coinsurance, while Chiropractic Services are covered with 20% coinsurance, but routine care is not covered. Occupational Therapy Services have 20% coinsurance, and Physician Specialist Services have 0%-20% coinsurance. Mental Health and Psychiatric Services are covered with 20% coinsurance for both individual and group sessions, and Podiatry Services are covered with 20% coinsurance for routine foot care. Other Health Care Professional services are covered with 0%-20% coinsurance, Physical Therapy and Speech-Language Pathology Services have 20% coinsurance, and Additional Telehealth Benefits have a $0-$45 copay and 20% coinsurance. Opioid Treatment Program Services are covered with 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, with varying copays and maximum plan benefit coverage amounts. Other preventive services have a 20% coinsurance, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams and prescription hearing aids are covered under the Aetna Medicare Community Complete (HMO D-SNP) plan. Routine hearing exams have no copay and a 20% coinsurance, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids have a maximum benefit of $1500 per year with no copay, while inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams have no copay, and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum plan benefit coverage amount of $405 per year for eyewear.
Dental Services See details
Dental Services has a coinsurance of 20% for Medicare Dental Services, with a maximum plan benefit of $1750 per year. Oral exams, dental x-rays, other diagnostic dental services, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics removable, prosthodontics 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, and require prior authorization. Medicare Part B Insulin Drugs have 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 Community Complete (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered items, and Diabetic Supplies have no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Community Complete (HMO D-SNP) plan. All diagnostic services have no copay, with coinsurance at most 20%, while diagnostic and therapeutic radiological services, and outpatient X-ray services also have no copay with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Community Complete (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Aetna Medicare Community Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $220 per month, and provides a meal benefit with no copay. Acupuncture and several other services are not covered.
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