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Aetna Medicare Full Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (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 Full Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Austin. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual (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 Full Dual (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 Full Dual (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 Full Dual (HMO D-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. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 Full Dual (HMO D-SNP) features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a standard copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, costs are based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand-name drugs have a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care, specialist visits, home health, and skilled nursing. For hospital care, inpatient admissions require an $1,880 copay, while outpatient services feature no copays and up to 20% coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, while urgent care visits require a $40 copay. Supplemental benefits include dental coverage up to $1,250 annually and an eyewear allowance up to $350, both featuring no copays for most services. Members also receive a hearing aid allowance of up to $2,000 per year and an over-the-counter allowance of up to $120 monthly with no copays or coinsurance. Routine transportation is also covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,880 copay per admission and no coinsurance, though prior authorization is required. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers outpatient services with no copays, with coinsurance ranging from no coinsurance to 20% depending on the service. These covered benefits include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, though prior authorization is required for most treatments.
Partial Hospitalization See details
Aetna Medicare Full Dual (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, your costs will either be a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Full Dual (HMO D-SNP) plan 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, urgent, and transportation services are covered up to a $250,000 maximum benefit with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual (HMO D-SNP) covers primary care, specialist visits, physical and occupational therapy, mental health, and telehealth services with no copays and no coinsurance. Routine podiatry is covered for up to 12 visits per year with no copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Full Dual (HMO D-SNP) are partially covered, featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while excluding in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling. Additionally, kidney disease education and screenings like glaucoma and diabetes self-management require no copay and a 20% coinsurance.
Hearing Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers hearing services, including annual routine exams with a 20% coinsurance and no copay, and annual fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 yearly, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers vision services with no deductible, offering one annual routine eye exam with no copay and 20% coinsurance, alongside follow-up diabetic eye exams with no copay or coinsurance. Eyewear is covered up to a $350 annual limit with no copays, featuring no coinsurance for eyeglasses and a 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), providing up to $1,250 annually with no copay and no coinsurance for most preventive and comprehensive dental care, while Medicare-covered dental requires no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Full Dual (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Members pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no copay under Aetna Medicare Full Dual (HMO D-SNP), but key programs including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond standard Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), offering no copay and no coinsurance for chronic illness meal benefits, wellness exams, and up to $120 monthly in over-the-counter item reimbursements. Acupuncture is not covered under this benefit.
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