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Aetna Medicare Prime Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime 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 Prime Chronic Care (HMO C-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Prime 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 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 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 Prime 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 Prime 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 Prime 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 $300.00 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:
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Drug Coverage
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at a preferred pharmacy and a $12 copay at a standard pharmacy. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan offers a range of benefits with varying cost-sharing. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays, and emergency services with copays. Primary care, preventive services, and vision services have no copay, while dental services have a copay. Additional benefits include coverage for hearing exams, home health services, and medical equipment. The plan also covers ambulance services, partial hospitalization, and skilled nursing facilities. This plan has cost-sharing through copays and coinsurance for various services, including some outpatient services, mental health, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a copay of $485 for days 1-5, and no copay for days 6-90; for psychiatric care, you will pay a copay of $455 for days 1-5, and no copay for days 6-90. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. You will pay a $60 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. Ground ambulance services have a $345 copay, while air ambulance services have a 20% coinsurance. 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 by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. Emergency Services have a $120 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $120 copay, while Worldwide Emergency Transportation has a $345 copay.
Primary Care See details
Under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, Primary Care Physician Services have no copay, Chiropractic Services have a $20 copay, Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a copay between $0 and $35. Mental Health Specialty Services, including individual and group sessions, have a $35 copay. Podiatry Services and Other Health Care Professional services have copays between $0 and $0. Psychiatric Services, including individual and group sessions, have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $55. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services with a copay. Kidney Disease Education Services have a 20% coinsurance, and other preventive services, such as glaucoma screenings, have no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids have a maximum plan benefit coverage of $500 per year, and Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay. The plan covers routine eye exams with no copay, and other eye exam services with no copay, along with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay, with a combined maximum of $375 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 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, Periodontics, and Oral and Maxillofacial Surgery have a 20% - 50% coinsurance. Endodontics and Prosthodontics, removable have a 20% and 50% coinsurance respectively, and Prosthodontics, fixed has a 50% coinsurance. Fluoride treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring 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 Care (HMO C-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay of $0-$20, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $195, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan 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 covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, but the specific services are not covered. The plan mentions that there is a copay for these services, but does not specify the amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; this plan does not cover additional days beyond Medicare-covered or non-Medicare-covered stays.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and Other 1 and Other 2 services with no copay. Acupuncture, Dual Eligible SNPs, 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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