A non-government entity
Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual Care (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 Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Houston and Surrounding Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual Care (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 Care (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 Care (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 Care (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.
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:
Sign up for Aetna Medicare Full Dual Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Full Dual Care (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order services. For Tier 2 generic medications, standard pharmacy and mail order refills require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher-tier medications under this plan are subject 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 both carry a 25% coinsurance. These percentage-based costs apply to all standard fill lengths, though Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers robust coverage with no copays and no coinsurance for primary care, specialist visits, home health care, and skilled nursing facility services. Inpatient hospital stays require a $1,790 copay per stay, while outpatient hospital services feature no copays and a coinsurance ranging from 0% to 20%. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes dental, vision, and hearing benefits with no copays, though some routine services and materials have a 20% coinsurance up to specified annual limits. Additionally, members benefit from up to 24 one-way transportation trips per year and durable medical equipment with no copay and a 20% coinsurance. Other valuable extras include a $135 monthly over-the-counter reimbursement and covered diagnostic services with no copays.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,790 copay per stay, no coinsurance, and required prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though coinsurance ranging from 0% to 20% applies to hospital, ambulatory surgical, and substance abuse services. Outpatient blood services also feature no copay and a 20% coinsurance, with no deductible and the cost waived for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services with prior authorization. Depending on the service, you will owe either no copay and a 20% coinsurance, or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers ambulance services with no copay and a coinsurance of 19% for ground and 20% for air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay 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 services are covered up to a $250,000 maximum with no copay and no coinsurance, except for worldwide emergency transportation which has a 19% coinsurance.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist visits, therapies, mental health, podiatry, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), with many services like annual physical exams and health education requiring no copay and no coinsurance. However, other services like kidney disease education and glaucoma screenings have no copay but a 20% coinsurance, while sub-services such as medical nutrition therapy, weight management, and alternative therapies are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $2,000 per ear annually with no copay or coinsurance; however, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductible, providing routine and follow-up diabetic eye exams with no copay, though routine exams are subject to a 20% coinsurance. Covered eyewear—including lenses, frames, and contact lenses—carries no copay up to a $375 annual limit, with contact lenses requiring a 20% coinsurance.
Dental Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and 20% coinsurance, alongside other preventive and comprehensive dental services with no copay and no coinsurance up to a $1,250 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual Care (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 radiology, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers some services covered for cardiac rehabilitation with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. This benefit is partially covered, as additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a $135 monthly over-the-counter reimbursement, chronic illness meals, and annual wellness exams. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved