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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 Southwestern 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 $16.10. 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) plan features an annual prescription drug deductible of $615. Members enjoy no copay on Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order. This zero-dollar cost sharing applies to one-month, two-month, and three-month supplies. For higher-tier prescriptions, costs are based on coinsurance percentages rather than flat copays. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred Drug) prescriptions carry a 25% coinsurance for standard retail and mail-order fills. Tier 5 (Specialty Tier) drugs also require a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Community HealthChoices (HMO D-SNP) plan offers comprehensive coverage for core medical needs, featuring no copays for primary care visits, outpatient hospital services, and home health care, though outpatient services carry a 20% coinsurance. Inpatient acute hospital stays require a $2,230 copay per stay, while emergency room visits have a $115 copay that is waived if you are admitted within 24 hours. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. For additional wellness needs, the plan provides robust dental, vision, and hearing benefits, including no copays for routine eye exams, up to $300 annually for eyewear, and up to $1,500 per ear annually for prescription hearing aids. Preventive and comprehensive dental services are covered with no copay up to a $1,500 annual limit, and diagnostic services generally require no copay with a 20% coinsurance. Members also benefit from practical extras like a $255 monthly over-the-counter allowance and up to 24 free one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Aetna Community HealthChoices (HMO D-SNP) covers inpatient acute hospital stays with a $2,230 copay per stay and inpatient psychiatric stays with a $2,080 copay per stay, both with no coinsurance and requiring prior authorization. However, additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and a 20% coinsurance, which applies to outpatient hospital, ambulatory surgical center, and substance abuse treatments. Prior authorization is required for most of these services, and the deductible is waived for the first three pints of outpatient blood services.
Partial Hospitalization See details
Aetna Community HealthChoices (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay 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. 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
Aetna Community HealthChoices (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 and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum benefit limit.
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 to 20%. For chiropractic care, some services are covered but routine and other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Community HealthChoices (HMO D-SNP), offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and glaucoma screenings feature no copay and a 20% coinsurance. Uncovered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Community HealthChoices (HMO D-SNP) covers hearing services with no deductible, including routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay. Prescription hearing aids are partially covered up to $1,500 per ear annually with no copay or coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Community HealthChoices (HMO D-SNP) with no deductibles, offering annual routine eye exams and follow-up diabetic exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is covered up to a $300 annual limit with no copay for frames, lenses, and upgrades, while contact lenses have no copay but require a 20% coinsurance.
Dental Services See details
Aetna Community HealthChoices (HMO D-SNP) offers partially covered dental services, featuring Medicare-covered dental care with no copay and 20% coinsurance, alongside other preventive and comprehensive dental services up to a $1,500 annual limit with no copay and no coinsurance. Under this plan, 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, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Community HealthChoices (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Community HealthChoices (HMO D-SNP) and generally requires prior authorization. Durable medical equipment, prosthetics, and medical supplies feature no copay and 20% coinsurance, while diabetic supplies from specified manufacturers are covered with no copay and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Community HealthChoices (HMO D-SNP) covers diagnostic and radiological services, including lab work, X-rays, and therapeutic radiology, 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 under Aetna Community HealthChoices (HMO D-SNP) with no copay, but only some services are covered in practice as 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
Skilled nursing facility (SNF) services are covered by Aetna Community HealthChoices (HMO D-SNP) with no coinsurance and do not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard 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 $255 monthly over-the-counter allowance, chronic illness meals, and select wellness exams. However, acupuncture is not covered under this benefit.
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