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Aetna Medicare Prime Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 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 Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-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 Prime Chronic Care (HMO C-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 $6750.00 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 Prime Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members enjoy no copay when using preferred pharmacies or preferred mail-order services, compared to a $2.00 copay for a one-month supply at standard locations. Tier 2 generic medications cost a $5.00 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $12.00 copay. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance across all pharmacy options. Specialty tier medications are limited to a one-month supply under this coverage.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan offers robust coverage with no copayments for primary care visits, routine physicals, and home health services. Specialist visits feature low copays ranging from $0 to $20, while emergency care carries a $130 copay that is waived if you are admitted. Inpatient hospital stays require a daily copay for the first few days but feature no copay for longer stays and no coinsurance overall. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copays, along with allowances for hearing aids and eyewear. Comprehensive dental services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, and members receive a $30 monthly allowance for over-the-counter items. Diagnostic services and medical equipment are widely covered, typically featuring no copays and low coinsurance.
Inpatient Hospital See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $485 copay for days 1 to 5 and no copay for days 6 to 90, while psychiatric stays require a $325 copay for days 1 to 6 and no copay for days 7 to 90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no coinsurance, featuring no copays for ambulatory surgical center services and outpatient blood services. Outpatient hospital services require a copay ranging from no copay to $325, observation services have a $485 copay per stay, and outpatient substance abuse sessions carry a $15 copay, with prior authorization required for most care.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with a copayment of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with prior authorization, offering ground ambulance services for a $290 copay and no coinsurance, and air ambulance services for a 20% coinsurance and no copay. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency services are also covered up to a $250,000 lifetime maximum with no coinsurance, requiring a $130 copay for emergency and urgent care and a $290 copay for emergency transportation.
Primary Care See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $20 copay with no coinsurance. Physical, occupational, psychiatric, and speech therapies require a $15 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) features partially covered preventive services, where annual physicals, fitness benefits, and screenings have no copay and no coinsurance, while kidney disease education carries no copay and a 20% coinsurance. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) offers partially covered hearing services, including Medicare-covered exams for a $20 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no deductibles and no coinsurance. Eye exams require a $0 to $15 copay, though routine annual exams and diabetic eye exams have no copay, and eyewear is covered with no copay up to a $100 annual maximum.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, which features a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and x-rays. Comprehensive options like restorative, endodontics, periodontics, prosthodontics, and oral surgery are covered up to a $1,500 yearly limit with no copay and 20% to 50% coinsurance. Fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs require a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copays, though prior authorization is required for these services. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices have a 20% coinsurance, and diabetic equipment is available with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. Lab services and diagnostic radiological services have no copay and no coinsurance, diagnostic tests require a $0 to $20 copay with no coinsurance, outpatient X-rays require a $20 copay and coinsurance, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, which excludes coverage for intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers other services with no copay and no coinsurance, including annual wellness exams, additional colon cancer screenings (gFOBT and FIT), and up to $30 monthly for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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* 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.
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