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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 2026 to people living in Select Texas 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 $2.00. 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) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a $10 copay for a one-month supply, a $20 copay for a two-month supply, and a $30 copay for a three-month supply. For higher-tier medications, costs are determined by coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard fills. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers robust medical coverage, featuring primary care and specialist visits with no copay and no coinsurance. For hospital services, there is a $1,700 copay per inpatient stay with no coinsurance, while outpatient care and diagnostic services generally require no copay and up to a 20% coinsurance. Emergency care is available with a $115 copay, which is waived upon hospital admission, alongside urgent care visits at a $40 copay. In addition to medical care, the plan provides dental coverage up to a $1,500 annual limit and vision benefits including a $350 eyewear allowance, both with no copay. Members also benefit from hearing aid coverage up to $2,000 per ear, a $160 monthly over-the-counter allowance, and up to 24 one-way transportation trips per year with no copay. Skilled nursing and home health services are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute hospital stays with a $1,700 copayment per stay and no coinsurance, offering unlimited additional days with no copay. Inpatient psychiatric hospital stays are covered with a $1,710 copayment per stay and no coinsurance, though 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 copay, though a coinsurance of 0% to 20% applies depending on the specific service. Covered benefits include outpatient hospital care, ambulatory surgical center services, outpatient substance abuse sessions, and blood services, with prior authorization required for most treatments.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services, subject to prior authorization. Depending on the specific service, you will pay either no copay and a 20% coinsurance, or a $110 copay and 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 prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered with no copay or coinsurance, offering up to 24 one-way trips per year to plan-approved locations, though 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, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers primary care, specialist visits, therapy, mental health, and podiatry services with no copay and no coinsurance. For chiropractic benefits, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney education and screenings require no copay and a 20% coinsurance. Uncovered services include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $2,000 per ear yearly, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductible, offering annual routine eye exams and follow-up diabetic eye exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is covered up to a $350 annual maximum with no copay for eyeglasses, lenses, frames, and upgrades, while contact lenses carry a 20% coinsurance and no copay.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering a $1,500 annual maximum with no copay and no coinsurance for preventive and most comprehensive treatments, while Medicare-covered dental services require no copay and a 20% coinsurance. 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, though prior authorization is required. Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no 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. Prior authorization is required to receive these 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, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Covered lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services have 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. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, but only some services are covered; specific treatments including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the 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, though acupuncture is not covered. Covered benefits include a $160 monthly over-the-counter allowance via reimbursement, chronic illness meals, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings.
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