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Aetna Medicare Prime Chronic Value (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Chronic Value (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Chronic Value (HMO C-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Chronic Value (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeastern Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime Chronic Value (HMO C-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 Prime Chronic Value (HMO C-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 Prime Chronic Value (HMO C-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 Prime Chronic Value (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.40. 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 $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 Prime Chronic Value (HMO C-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you'll pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Prime Chronic Value (HMO C-SNP) plan offers a variety of benefits with varying costs. You can expect no copay for primary care visits, routine hearing exams, preventive services, dental exams, and home health services. Many services have copays, such as hospital stays, specialist visits, outpatient services, and emergency care. The plan covers inpatient and outpatient services, including mental health and substance abuse treatment. It also includes coverage for hearing aids, vision services like eye exams and eyewear, and dental services, along with medical equipment and home infusion services. However, some services like cardiac rehabilitation and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 5 days, there is a $385 copay, and days 6-90 have no copay. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $300 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a $25 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Prime Chronic Value (HMO C-SNP). Ground ambulance services have a copay of $285, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for up to 6 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan, with a $110 copay for emergency services and a $45 copay for urgently needed services. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have copays, and the maximum plan benefit coverage for Worldwide Emergency Services is $50,000.
Primary Care See details
The Aetna Medicare Prime Chronic Value (HMO C-SNP) plan covers primary care physician services, with no copay. Chiropractic services have a $10 copay, while occupational therapy services have a $25 copay. Physician specialist services have a copay between $0 and $10. Mental health specialty services, including individual and group sessions, have a $25 copay, and psychiatric services, including individual and group sessions, also have a $10 copay. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services and additional services, such as an annual physical exam with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance, and other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing exams are covered with a $10 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$10, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $470 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $10 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and other dental services. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%, with 20% for endodontics, and 50% for prosthodontics (removable and fixed). Orthodontic services are covered up to a $2,500 maximum per year. However, fluoride treatment, 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. 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 by the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Prime Chronic Value (HMO C-SNP), with no copay for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Supplies and Therapeutic Shoes/Inserts. For DME, you may pay between 0% and 20% coinsurance, and for Medical Supplies, you may pay between 0% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay ranging from $0 to $15, and lab services with no copay. The plan also covers diagnostic radiological services with a copay up to $150 and therapeutic radiological services with a 20% coinsurance, as well as outpatient X-ray services with a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan with no copay and no coinsurance. However, 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 Prime Chronic Value (HMO C-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Chronic Value (HMO C-SNP) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Prime Chronic Value (HMO C-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $55.00 every month. The plan also covers a Meal Benefit with no copay, and annual wellness exams, screening mammography, gFOBT, and FIT 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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