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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 Northeastern 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 $14.20. 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 essential medications, the plan offers no copay for Tier 1 preferred generic and Tier 2 generic drugs when filled at standard pharmacies or through standard mail order. This $0 cost applies to one-month, two-month, and three-month supplies. For brand-name and specialty medications, costs are based on a percentage of the drug price. Members pay a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The Aetna Community HealthChoices (HMO D-SNP) offers comprehensive medical coverage with many essential services featuring no copayments, though coinsurance often applies. For instance, primary care and specialist visits require no copay with up to 20% coinsurance, while inpatient hospital stays carry a $2,140 copay per acute stay. Outpatient services and diagnostic tests generally carry a 20% coinsurance, while emergency room visits require a $115 copay that is waived upon admission. This plan also provides robust supplemental benefits, including dental and vision care with no copay up to generous annual limits of $1,500 and $300 respectively. Members also receive prescription hearing aids with no copay up to $1,500 annually, 24 free one-way transportation trips, and a $250 monthly over-the-counter reimbursement. Home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Community HealthChoices (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute inpatient stays require a $2,140 copay per stay, while psychiatric inpatient stays require a $1,995 copay per stay. Additional days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Aetna Community HealthChoices (HMO D-SNP) covers outpatient services with no copay, though 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 services, and there is no deductible for blood services.
Partial Hospitalization See details
Aetna Community HealthChoices (HMO D-SNP) covers partial hospitalization services with prior authorization required. Depending on the service, costs are 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 ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered with no copay or coinsurance. Covered transportation is limited to 24 one-way trips per year to plan-approved health-related locations, meaning 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, with the copay 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 and no coinsurance up to a maximum benefit of $250,000.
Primary Care See details
Primary care services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copays and a 20% coinsurance, while specialist visits feature no copays and 0% to 20% coinsurance. Most therapy, psychiatric, and podiatry services are also covered with no copays and 20% coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Aetna Community HealthChoices (HMO D-SNP) partially covers preventive services, offering annual physical exams and select supplemental benefits with no copay and no coinsurance, while kidney disease education and specific screenings require a 20% coinsurance and no copay. Sub-services that are not covered under this plan 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
Hearing services are covered by Aetna Community HealthChoices (HMO D-SNP) with no deductible, including Medicare-covered exams with a copay, one annual routine exam with a 20% coinsurance and no copay, and one fitting evaluation with no copay. Prescription hearing aids are partially covered up to $1,500 annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Community HealthChoices (HMO D-SNP) covers vision services with no deductible, offering annual routine eye exams and follow-up diabetic eye exams with no copay, though routine exams are subject to a 20% coinsurance. Prescription eyewear is covered up to a $300 annual limit with no copay for glasses, lenses, frames, and upgrades, while contact lenses require a 20% coinsurance and no copay.
Dental Services See details
Dental services are partially covered under Aetna Community HealthChoices (HMO D-SNP), featuring Medicare-covered dental with no copay and a 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Community HealthChoices (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and no coinsurance.
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 these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Community HealthChoices (HMO D-SNP), featuring durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay, diabetic therapeutic shoes or inserts carry a 20% coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and a 20% coinsurance, which includes lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays. Prior authorization is required for all of these covered services.
Home Health Services See details
Aetna Community HealthChoices (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Community HealthChoices (HMO D-SNP) with no copay, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Community HealthChoices (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and 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, providing chronic illness meals, annual wellness exams, additional gFOBT and FIT screenings, and a $250 monthly over-the-counter reimbursement with no copay and no coinsurance. Acupuncture is not covered under this plan benefit.
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