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Aetna Medicare Chronic Care Total (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care Total (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 Total (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care Total (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Kent, New Castle, Sussex counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care Total (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 Total (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 Total (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 Total (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.40. 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 $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 $9250.00 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 Chronic Care Total (HMO C-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month fills at standard pharmacies and through standard mail order. Tier 2 generic drugs carry a low copay of $5 for a one-month supply, which goes up to $10 for a two-month supply, and $15 for a three-month standard pharmacy fill or $10 for a three-month standard mail order fill. For higher-tier medications, including Tier 3 preferred brand drugs and Tier 4 non-preferred drugs, you will pay a 25% coinsurance for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. Tier 5 specialty tier drugs also require a 25% coinsurance for a one-month supply. These coinsurance rates apply equally to both standard pharmacy purchases and standard mail-order deliveries.
Additional Benefits
The Aetna Medicare Chronic Care Total (HMO C-SNP) offers robust coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, there is a $1,677 copay per admission with no coinsurance, while outpatient services feature no copays and coinsurance ranging from 0% to 20%. Emergency care is available with a $115 copay, which is waived if you are admitted, and urgent care visits require a $40 copay. This plan also includes valuable supplemental benefits, such as routine dental and vision care with no copay and up to 50% coinsurance for comprehensive dental services. Vision eyewear is covered with no copay up to a $250 annual limit, and prescription hearing aid fittings have no copay. Additionally, members benefit from no copays on diagnostic lab work and home infusion services, plus a $95 monthly allowance for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Chronic Care Total (HMO C-SNP) partially covers inpatient hospital services, requiring a $1,677 copayment per admission and no coinsurance for both acute and psychiatric stays. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Chronic Care Total (HMO C-SNP) with no copays, although coinsurance ranging from no coinsurance to 20% and prior authorization apply to hospital, ambulatory surgical center, and substance abuse services. Outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers partial hospitalization services with a copay of either $55.00 or $110.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance, offering up to 6 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers emergency services 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 and urgent care are covered up to a $250,000 maximum with a $115 copay and no coinsurance, and worldwide emergency transportation has a 20% coinsurance and no copay.
Primary Care See details
Primary care benefits under Aetna Medicare Chronic Care Total (HMO C-SNP) feature no copay and no coinsurance for primary care doctor and podiatry visits, though chiropractic services are not covered in practice. Specialist visits, therapy, and mental health services are covered with no copay and coinsurance ranging from 0% to 20%, while telehealth services may require a copay of up to $40 and 20% coinsurance.
Preventive Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) provides partially covered preventive services, offering no copay and no coinsurance for annual physicals, health education, and fitness benefits. A 20% coinsurance and no copay apply to kidney disease education and diabetes self-management, while several supplemental options like in-home safety assessments and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Chronic Care Total (HMO C-SNP), with routine hearing exams requiring a 20% coinsurance and no copay, and fitting evaluations and covered prescription hearing aids (up to $500 per ear annually) having no copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers vision services with no deductible, offering routine and follow-up diabetic eye exams for no copay and 0% to 20% coinsurance. Covered eyewear, including contacts, eyeglasses, frames, lenses, and upgrades, has no copay or coinsurance up to a $250 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Chronic Care Total (HMO C-SNP), offering preventive care like exams, cleanings, and x-rays with no copay and no coinsurance. Medicare-covered dental has no copay and a 20% coinsurance, while comprehensive services require no copay and a 20% to 50% coinsurance up to a $1,000 annual limit; however, fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Chronic Care Total (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers medical equipment with prior authorization required, offering no copay for durable medical equipment (DME), medical supplies, and diabetic supplies. Coinsurance ranges from no coinsurance to 20% for DME and medical supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Chronic Care Total (HMO C-SNP) with prior authorization required. Diagnostic procedures, lab services, and diagnostic radiological services require no copay and no coinsurance, while therapeutic radiological services and outpatient X-ray services require no copay and a 20% coinsurance.
Home Health Services See details
Aetna Medicare Chronic Care Total (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 offered by Aetna Medicare Chronic Care Total (HMO C-SNP) where some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice. There is no copay for cardiac and intensive cardiac rehabilitation services, while pulmonary and SET for PAD services require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care Total (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and prior authorization required, 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 standard Medicare limit are not covered.
Other Services See details
Aetna Medicare Chronic Care Total (HMO C-SNP) provides partially covered other services, featuring no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and up to $95 monthly for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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