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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 Northeastern 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 $29.00. 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 deductible for prescription drugs. Once the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy type until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. Those who qualify for the low-income subsidy will pay $29 per month for Part D.
Additional Benefits
The Aetna Medicare Community Complete (HMO D-SNP) plan offers a range of benefits. Inpatient hospital stays have a $1,995 copay per admission, while outpatient services, including some substance abuse services, have a 20% coinsurance. Emergency services have a copay of $110, and urgently needed services have a $45 copay. Preventive services have no copay, while many other services, like primary care, hearing, vision, and dental, have either a copay or coinsurance. The plan also covers ambulance services, home health, and medical equipment with varying cost-sharing structures. The plan also offers additional benefits such as OTC items and a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $1,995 per admission or stay. Additional days, and non-Medicare covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services are covered by Aetna Medicare Community Complete (HMO D-SNP), including outpatient hospital, observation, and substance abuse services, with a 20% coinsurance. Outpatient blood services are also covered with a 20% coinsurance, and the plan waives the three (3) pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Community Complete (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance, are covered by the Aetna Medicare Community Complete (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay, with up to 12 one-way trips per year covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Community Complete (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
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 are covered. Primary Care Physician Services and Chiropractic Services have a 20% coinsurance, while Occupational Therapy Services has a 20% coinsurance, and no copay. Physician Specialist Services have a 0-20% coinsurance. Mental Health Specialty Services, including individual and group sessions, have a 20% coinsurance. Podiatry Services have a 20% coinsurance and no copay. Other Health Care Professional services have a 0-20% coinsurance. Psychiatric Services, including individual and group sessions, have a 20% coinsurance. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance and no copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing Services include Routine Hearing Exams and Fitting/Evaluation for Hearing Aids with no copay and a coinsurance of at most 20% for Routine Hearing Exams. Prescription Hearing Aids (all types) are covered with no copay. OTC Hearing Aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a 20% coinsurance, and routine eye exams and other eye exam services have no copay. Eyewear is covered, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, with a 20% coinsurance; contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay, and there is a combined maximum plan benefit of $300 every year.
Dental Services See details
The Aetna Medicare Community Complete (HMO D-SNP) plan covers dental services with a 20% coinsurance, and an annual maximum of $2,000. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have visit limits. 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. This plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Community Complete (HMO D-SNP) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. 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, with no copay. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%, 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 Community Complete (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Community Complete (HMO D-SNP), but none of the sub-services are covered, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. There is coinsurance for some services, but no copay is mentioned.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay is not specified in the provided information.
Other Services See details
The Aetna Medicare Community Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) items and Meal Benefit with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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.
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