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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 Dallas 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. 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 Care (HMO D-SNP) plan features an annual prescription drug deductible of $615. Tier 1 preferred generic drugs are covered with no copay for standard pharmacy and standard mail-order fills. Tier 2 generic drugs require a copay of $10 for a 1-month supply, $20 for a 2-month supply, and $30 for a 3-month supply. Tier 3 preferred brand drugs carry a 22% coinsurance for standard pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty medications both require a 25% coinsurance. Specialty tier medications are limited to a 1-month supply for standard pharmacy and mail-order fills.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers robust healthcare coverage, with many essential services featuring no copay and no coinsurance. For example, primary care, specialist visits, home health services, and skilled nursing facility care require no copay or coinsurance. However, inpatient hospital stays require a $1,940 copay per stay, and emergency room visits carry a $115 copay that is waived if you are admitted. Supplemental benefits are also highly accessible, featuring no deductible for vision services and no copays for dental, vision, and hearing care. While routine exams and medical equipment often require a 20% coinsurance, prescription hearing aids are covered up to $2,000 per ear with no copay or coinsurance. Additionally, the plan includes a $140 monthly allowance for over-the-counter items and up to 24 one-way transportation trips per year at no cost.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,940 copay per stay 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
Outpatient services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though coinsurance ranges from no coinsurance to 20% depending on the service. Prior authorization is required for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, while blood services have no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Full Dual Care (HMO D-SNP) plan, with prior authorization required. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Full Dual Care (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered with no copay or coinsurance, offering up to 24 one-way trips per year to plan-approved locations via rideshare, public transit, or medical transport.
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 admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $250,000 with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist visits, physical therapy, mental health, and podiatry services with no copay and no coinsurance. Chiropractic services are not covered, and prior authorization is required for certain benefits such as psychiatric sessions and opioid treatment.
Preventive Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals and select supplemental benefits, though kidney disease education and other screenings carry a 20% coinsurance and no copay. Specific sub-services, including weight management, nutritional benefits, and in-home support, are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring annual routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $2,000 per ear yearly with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductible, offering one routine eye exam and follow-up diabetic eye exams per year with no copay and a 20% coinsurance for routine exams. Eyewear is covered with no copay up to a $375 annual limit, though contact lenses are subject to a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering preventive and comprehensive care with no copay and no coinsurance up to a $1,250 annual maximum, while Medicare-covered dental services require a 20% coinsurance and no copay. Most dental services are covered, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
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, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts carry 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 copayments. Patients will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers cardiac rehabilitation services with no copay, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. While the plan allows admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers partial coverage for other services, excluding acupuncture. Covered benefits such as over-the-counter items up to $140 monthly, chronic illness meals, annual wellness exams, mammographies, and additional FIT and gFOBT screenings feature no copay and no coinsurance.
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