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Aetna Medicare Dual Preferred (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Preferred (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual Preferred (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Texas Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Preferred (HMO D-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 Dual Preferred (HMO D-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 Dual Preferred (HMO D-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 Dual Preferred (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.70. 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 $590.00 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 $9350.00 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 Dual Preferred (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your prescriptions based on the drug tier, pharmacy, and the days supply. If you qualify for the low-income subsidy (LIS), your Part D premium will be $11.70. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a copay, while outpatient services and partial hospitalization have coinsurance requirements. Primary care, preventive services, hearing, vision, dental, and other services like home health and diagnostic services are covered with either no copay or coinsurance. This plan also includes coverage for ambulance, emergency, and transportation services, along with benefits like over-the-counter items and meal benefits. However, it's important to note some services, like cardiac rehabilitation, additional home health care, and certain dental and vision services, may not be covered or have limitations.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, there is a copay of $1820 per admission or stay, and additional days are covered with no copay. Inpatient Hospital Psychiatric has a copay of $1830 per admission or stay.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a coinsurance of 0% to 20%, observation services with a 20% coinsurance, ambulatory surgical center services with a coinsurance between 0% and 20%, outpatient substance abuse services with a 20% coinsurance, and outpatient blood services with a 20% coinsurance. The plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered, including ground and air ambulance services with a 20% coinsurance, and transportation services to plan-approved health-related locations with no copay. 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 Dual Preferred (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers primary care physician services, chiropractic services, physician specialist services, occupational therapy services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Mental health and psychiatric services are covered with no copay for individual and group sessions. Podiatry services and other health care professional services are covered with no copay. However, routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers preventive services with a $0 copay for annual physical exams. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications, and Kidney Disease Education Services, with a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with at most 20% coinsurance, and fitting/evaluation for hearing aids and routine hearing exams have no copay. Prescription hearing aids are covered, with a maximum benefit of $2000 per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum plan benefit coverage amount of $290.00 per year for eyewear.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services that require prior authorization and a $1,000 annual maximum for other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but may have visit limits and other restrictions. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment benefits are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, and requires authorization. Prosthetic devices have a 20% coinsurance with no copay, and medical supplies have a 20% coinsurance with no copay. Diabetic supplies have no coinsurance, while diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. All diagnostic services and radiological services are covered with no copay, while diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Although the plan covers some cardiac rehabilitation services, the specific services offered by the plan are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Preferred (HMO D-SNP), but the plan does not cover additional days beyond Medicare-covered SNF or non-Medicare-covered SNF stays. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1, but specific copay and coinsurance information is not provided.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $125.00 every month. The plan also covers Meal Benefits and Other 1 and Other 2 services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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