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Aetna Medicare Chronic Care Value (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care 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 Chronic Care Value (HMO C-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Chronic Care Value (HMO C-SNP) is a HMO C-SNP plan offered by Aetna Health Inc. (PA) available for the 2026 plan year to people living in Western Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care 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 Chronic Care 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 Chronic Care 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 Chronic Care Value (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.80. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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:
Sign up for Aetna Medicare Chronic Care Value (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care Value (HMO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one, two, or three-month supplies through standard pharmacies and standard mail order. For Tier 2 generic drugs, you will pay a copay starting at $5 for a one-month supply, up to a $15 copay for a three-month standard pharmacy supply or a $10 copay for a three-month standard mail order supply. For higher-tier medications, including Tier 3 preferred brand drugs and Tier 4 non-preferred drugs, the plan charges a 25% coinsurance for one, two, or three-month supplies at standard pharmacies and standard mail order. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply. These structured cost-sharing details help you estimate your out-of-pocket prescription expenses when choosing this Medicare Advantage plan.
Additional Benefits
The Aetna Medicare Chronic Care Value (HMO C-SNP) offers comprehensive coverage for core medical needs, featuring no copay for primary care doctor visits and routine podiatry. Specialist visits, therapy services, and diagnostic laboratory tests also feature low costs, ranging from no copay to a maximum of $10. For inpatient hospital stays, members pay a daily copay of $385 for the first five days and no copay for days six through ninety, while emergency room visits carry a $115 copay that is waived upon admission. This plan also includes valuable supplemental benefits, such as preventive dental, routine vision, and annual hearing exams with no copay or coinsurance. Members receive up to $300 annually for eyewear, $500 per ear for hearing aids, and a monthly allowance of up to $55 for over-the-counter items with no copay. Additionally, routine transportation is covered for up to six one-way trips per year to plan-approved locations at no cost to the member.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Chronic Care Value (HMO C-SNP) with no coinsurance and prior authorization required, costing a $385 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care Value (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $385 copay for outpatient hospital services and a $385 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $10 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Chronic Care Value (HMO C-SNP) covers partial hospitalization services with a copay of either $55.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Chronic Care Value (HMO C-SNP), with ground ambulance services requiring a $285 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 6 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Aetna Medicare Chronic Care Value (HMO C-SNP) plan are covered with a $115 copay and no coinsurance, which is 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 up to a $250,000 maximum with copays ranging from $115 to $285 and no coinsurance.
Primary Care See details
Primary care benefits under the Aetna Medicare Chronic Care Value (HMO C-SNP) are covered with no copay and no coinsurance for primary care doctor visits and routine podiatry (up to 6 visits per year), while specialist, therapy, mental health, and opioid treatment services require a $0 to $10 copay and no coinsurance. Some chiropractic services are covered with a $10 copay and no coinsurance, but routine and other chiropractic care are not covered, and telehealth benefits carry a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Chronic Care Value (HMO C-SNP), offering annual exams, health education, fitness benefits, and remote access technologies with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Aetna Medicare Chronic Care Value (HMO C-SNP) covers Medicare-covered hearing exams for a $10 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care Value (HMO C-SNP) with no deductibles or coinsurance, offering eye exams for a $0 to $10 copay, which includes one routine exam per year at no copay. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to a $300 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care Value (HMO C-SNP), featuring no copay or coinsurance for preventive care like exams and cleanings, and a $10 copay with no coinsurance for Medicare-covered dental. Comprehensive services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Aetna Medicare Chronic Care Value (HMO C-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Chronic Care Value (HMO C-SNP) 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 Medicare Chronic Care Value (HMO C-SNP) with no copays, featuring 0% to 20% coinsurance for durable medical equipment (DME) and medical supplies, and 20% coinsurance for prosthetic devices. Diabetic equipment and supplies are covered with no copays and no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Chronic Care Value (HMO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $15 copay for diagnostic tests, while radiological services require a $10 copay for x-rays, starting at no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Chronic Care Value (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Chronic Care Value (HMO C-SNP) with no copay and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Chronic Care Value (HMO C-SNP) with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Chronic Care Value (HMO C-SNP) are partially covered, offering no copay and no coinsurance for annual wellness exams, select cancer screenings, and over-the-counter items up to $55 per month. Acupuncture, meal benefits, and certain other services are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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