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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 Lehigh Valley 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 $14.40. 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 has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members enjoy no copay for one-month, two-month, and three-month supplies filled at standard pharmacies and standard mail order. This plan provides highly cost-effective coverage options for everyday generic medications. For brand-name and specialty prescriptions, costs are calculated using coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty tier drugs also incur a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Community HealthChoices (HMO D-SNP) plan offers comprehensive medical coverage with no copayments for primary care, specialist visits, and outpatient hospital services, though these services typically require a twenty percent coinsurance. Inpatient hospital stays require copayments of two thousand one hundred sixty dollars for acute care and one thousand nine hundred seventy-five dollars for psychiatric care, both with no coinsurance. Emergency room visits carry a one hundred fifteen dollar copayment, while urgent care visits require a forty dollar copayment, with no coinsurance for either service. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care up to a fifteen hundred dollar annual limit with no copays or coinsurance. Additionally, members benefit from hearing aid coverage up to fifteen hundred dollars per ear annually, twenty-four free one-way transportation trips, and up to two hundred fifty dollars per month for over-the-counter items. Vision services are also covered, featuring routine eye exams with no copay and a twenty percent coinsurance, alongside a three hundred dollar annual allowance for eyewear with no copay.
Inpatient Hospital See details
Aetna Community HealthChoices (HMO D-SNP) partially covers inpatient hospital services with prior authorization required and no coinsurance, requiring a $2,160 copayment per stay for acute care and a $1,975 copayment per stay for psychiatric care. Additional days, non-Medicare-covered stays, and acute care upgrades are not covered.
Outpatient Services See details
Outpatient services under the Aetna Community HealthChoices (HMO D-SNP) are covered with no copay and a 20% coinsurance for outpatient hospital, observation, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for 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, subject to prior authorization. Additionally, the plan provides up to 24 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are 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 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 copays or coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Primary care services under Aetna Community HealthChoices (HMO D-SNP) are covered with no copay and 20% coinsurance for most care, including primary care physician visits, therapy services, and mental health sessions, while specialist visits feature no copay and no coinsurance to 20% coinsurance. Chiropractic services are not covered, but telehealth benefits are available with no copay to a $40 copay and 20% coinsurance.
Preventive Services See details
Aetna Community HealthChoices (HMO D-SNP) partially covers preventive services, offering annual physicals and select health benefits with no copay and no coinsurance, while kidney education and screenings like glaucoma and diabetes training require a 20% coinsurance and no copay. Services not covered under this plan include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Community HealthChoices (HMO D-SNP), featuring routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Vision services are covered by Aetna Community HealthChoices (HMO D-SNP) with no deductibles, including one routine eye exam annually with no copay and 20% coinsurance. Eyewear is covered with no copays up to a $300 annual maximum, though contact lenses require a 20% coinsurance.
Dental Services See details
Aetna Community HealthChoices (HMO D-SNP) covers Medicare dental services with no copay and a 20% coinsurance, and offers other preventive and comprehensive dental services with no copay and no coinsurance up to a $1,500 annual limit. While many dental benefits are covered, 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, though prior authorization is required. Additionally, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under Aetna Community HealthChoices (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Community HealthChoices (HMO D-SNP) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Aetna Community HealthChoices (HMO D-SNP) covers diagnostic and radiological services, including lab services, X-rays, and therapeutic radiological services, with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Home Health Services See details
Aetna Community HealthChoices (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Community HealthChoices (HMO D-SNP) with no copay, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Community HealthChoices (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. 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 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 chronic illness meal benefits, annual wellness exams, additional screening tests, and up to $250 per month in over-the-counter items. Acupuncture is not covered under this plan benefit.
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