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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 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 (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) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. Tier 2 generic prescriptions are also highly affordable, with copayments starting at $5.00 for a one-month supply at preferred pharmacies. Higher-tier medications transition to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These cost-sharing details help beneficiaries plan for their monthly medication expenses with the Aetna Medicare Chronic Care (HMO C-SNP) plan.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits and routine eye exams are highly affordable, requiring a copay of up to $20 or no copay at all. For urgent or intensive care, emergency room visits carry a $130 copay, while inpatient hospital stays require daily copays for the first five days followed by no copay for the remaining covered days. Members also benefit from valuable extras, including routine dental and hearing exams with no copay, alongside annual allowances of $500 per ear for prescription hearing aids and $100 for eyewear. Additionally, the plan provides up to a $30 monthly allowance for over-the-counter items with no copay. Skilled nursing facility care is available with no coinsurance, requiring a low $10 daily copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, requiring a $400 daily copay for days 1 to 5 of an acute stay and a $300 daily copay for days 1 to 5 of a psychiatric stay, followed by no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, or non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services and a $400 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $20 copay per session with no coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ambulance services with a $275 copay for ground transport and a 20% coinsurance for air transport, both of which require prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) offers primary care and podiatry services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a copay of up to $20 with no coinsurance. Chiropractic services are not covered, and additional telehealth services are available with a 20% coinsurance and a copay ranging from $0 to $50.
Preventive Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers preventive services, including annual physical exams, health education, and diabetes self-management training with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several supplemental benefits like nutritional therapy, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Medicare-covered hearing exams with a $20 copay and no coinsurance, while routine exams and fitting evaluations are covered annually with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay or coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers vision services with no coinsurance, offering eye exams with a copay ranging from no copay to $20, including annual routine exams with no copay. Covered eyewear, including contacts, lenses, and frames, has no copay and is subject to a $100 annual combined maximum limit.
Dental Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers partially covered dental services, featuring Medicare-covered dental with a $20 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive dental services are covered up to a $500 annual maximum with no copay and 20% to 50% coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental 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, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Aetna Medicare Chronic Care (HMO C-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment and medical supplies carry no coinsurance to 20% coinsurance, prosthetics have a 20% coinsurance, and diabetic equipment is covered with no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers diagnostic and radiological services with no copay and no coinsurance for lab services, diagnostic procedures, and diagnostic radiology. Outpatient x-rays require a $25 copay, while therapeutic radiological services carry a 20% coinsurance, with prior authorization required for these benefits.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, but only some services are covered as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services with no copay and no coinsurance, including annual wellness exams, screening mammography, additional gFOBT and FIT, and up to $30 monthly for over-the-counter (OTC) items. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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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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