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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (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 (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2025 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 (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 (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 (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 (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $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 $6750.00 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:
Sign up for Aetna Medicare Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through preferred mail order, while standard pharmacies charge a small copay starting at $2. Tier 2 generic drugs are also affordable, with copays starting at $5 at preferred locations compared to a $12 copay at standard locations. For higher-tier medications, cost-sharing transitions to coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, routine podiatry, and preventive services. Specialist visits, physical therapy, and mental health services are also highly affordable, carrying copays ranging from $0 to $25 with no coinsurance. For urgent care and emergency services, members pay copays of $50 and $130, respectively, while inpatient hospital stays require a copay of up to $520 per day for the first five days and no copay for subsequent days. In addition to standard medical care, this plan provides valuable coverage for routine dental, vision, and hearing services, including no copay for routine eye and hearing exams. Members also benefit from a $100 annual eyewear allowance, up to $500 per ear yearly for prescription hearing aids, and a $35 monthly reimbursement for over-the-counter items. Home health services and diabetic supplies are fully covered with no copays, while other durable medical equipment and dialysis services require a 0% to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute hospital stays with no coinsurance and a $520 copay for days 1 to 5, and inpatient psychiatric stays with no coinsurance and a $465 copay for days 1 to 5, with no copay for days 6 to 90 for both. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $485 copay for outpatient hospital services and a $485 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Chronic Care (HMO C-SNP) covers partial hospitalization services with a copay of $60.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under Aetna Medicare Chronic Care (HMO C-SNP), as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $315 copay and no coinsurance, while air ambulance services require 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Emergency services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays of $130 for emergency or urgent care and $315 for transportation.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care physician visits and routine podiatry with no copay and no coinsurance. Specialist visits, physical and occupational therapies, mental health, and psychiatric services require copays of $0 to $25 with no coinsurance, while telehealth has a $0 to $50 copay and 20% coinsurance. Chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) provides partially covered preventive services, including annual physicals, health education, smoking cessation, fitness, remote access, and select screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Not covered under this benefit are in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with a $25 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations at no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear yearly, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no deductibles or coinsurance, featuring no copay for annual routine eye exams and a $100 yearly limit on eyewear. Medicare-covered eye exams are also available with no coinsurance and a copay of $0 to $25.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP), featuring Medicare-covered dental for a $25 copay and no coinsurance, and preventive care with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $500 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and require prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices require a 20% coinsurance, and diabetic equipment and supplies are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic tests range from no copay up to a $20 copay with no coinsurance, while outpatient X-rays require a $20 copay with coinsurance, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan, with intensive cardiac, pulmonary, and supervised exercise therapy (SET) services all being excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance for covered benefits, which include a $35 monthly reimbursement for over-the-counter items, annual wellness exams, screening mammographies, and additional gFOBT and FIT. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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