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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 Lehigh Valley 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 $30.20. 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 $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 you meet your deductible, you will pay the costs for your drugs based on their tier until your total drug costs reach $2,000. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $30.20. After your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Community Complete (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $1,975 copay per admission, while outpatient services and blood services have a 20% coinsurance. Emergency services have a $110 copay, and urgently needed services have a $45 copay. The plan provides coverage for a variety of other services, including primary care, preventive services, hearing, vision, dental, and home health services. Many preventive services and home health services have no copay, and hearing aids have no copay up to $1500 per ear per year. However, many services, such as ambulance, mental health, and dental services, have a 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under this plan. You will pay a copay of $1,975 per admission or stay for Medicare-covered inpatient hospital stays, and additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services and Observation Services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are also covered. Outpatient Blood Services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Community Complete (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 12 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Community Complete (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each 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, and Routine Chiropractic Care is not covered. Occupational Therapy Services has a 20% coinsurance and no copay. Physician Specialist Services have a coinsurance between 0% and 20%. Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, and Group Sessions for Mental Health Specialty Services have a 20% coinsurance. Podiatry Services have a 20% coinsurance and no copay for Medicare-covered services. Other Health Care Professional services have a coinsurance between 0% and 20%. Psychiatric Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services 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 $0.00 and $45.00. Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay, and additional preventive services, including Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered, with a 20% coinsurance for routine hearing exams, and no copay for Medicare-covered benefits, fitting, and evaluations for hearing aids. Prescription hearing aids (all types) are covered with no copay, and a maximum benefit of $1500 per year, per ear, 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 are covered, including eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and other eye exam services have no copay. Eyewear has a 20% coinsurance, and a combined maximum plan benefit coverage of $335 per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with a 20% coinsurance for Medicare Dental Services. Other dental services have a $2,000 maximum benefit per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Community Complete (HMO D-SNP) plan. You will pay 20% coinsurance for this service, and prior authorization is required.
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, 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. For all diagnostic services, there is no copay and the coinsurance is not specified. For Diagnostic Procedures/Tests and Lab Services, the coinsurance is at most 20%. For Diagnostic Radiological Services, there is no copay and the coinsurance is at most 20%, while for Therapeutic Radiological Services and Outpatient X-Ray Services, the coinsurance is at most 20%.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Community Complete (HMO D-SNP) 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 not covered by the Aetna Medicare Community Complete (HMO D-SNP) plan. The plan does not cover any services related to Cardiac Rehabilitation.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Community Complete (HMO D-SNP) plan, but prior authorization is required. The plan covers SNF services with the Medicare-defined cost share for tier 1, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Community Complete (HMO D-SNP) plan's "Other Services" benefit covers over-the-counter items and meal benefits with no copay, and also covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, dual eligible SNPs, EPSDT, private duty nursing, and other services are not covered.
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