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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 San Antonio. 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:
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Drug Coverage
The Aetna Medicare Prime Chronic Care (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when filling prescriptions through preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a one-month supply at preferred locations compared to a $12 copay at standard pharmacies. For higher-tier medications, costs are structured as 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 carry a 25% coinsurance. These coinsurance rates remain the same whether you use preferred or standard pharmacies and mail order services.
Additional Benefits
The Aetna Medicare Prime Chronic Care (HMO C-SNP) offers robust medical coverage featuring no copay and no coinsurance for primary care, routine dental cleanings, and home health services. Specialist visits and routine eye exams also require no copay, while inpatient hospital stays require daily copays ranging up to $485 with no coinsurance. Emergency care is covered with a $130 copay, and urgently needed services carry a $50 copay, both with no coinsurance. For supplemental benefits, the plan provides up to $500 per ear annually for prescription hearing aids with no copay, a $175 annual limit for covered eyewear, and comprehensive dental care with 20% to 50% coinsurance. Diagnostic lab work and medical equipment feature no copay, though durable medical equipment carries a 0% to 20% coinsurance. Members also receive a $30 monthly reimbursement for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) inpatient hospital benefits are partially covered with no coinsurance, requiring prior authorization and a daily copay of $485 for days 1 to 5 of acute stays and $325 for days 1 to 6 of psychiatric stays, with no copay thereafter. 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 across all categories. Ambulatory surgical center and blood services feature no copay, while outpatient hospital services range from no copay up to a $350 copay, observation services require a $485 copay per stay, and substance abuse sessions carry a $15 copay.
Partial Hospitalization See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers partial hospitalization services with a copay ranging from $60 to $145 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance up to a $250,000 limit, requiring a $130 copay for emergency or urgent services and a $300 copay for worldwide emergency transportation.
Primary Care See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers primary care and podiatry services with no copay and no coinsurance, while specialist visits require a $0 to $20 copay with no coinsurance. Physical, occupational, mental health, and psychiatric therapies have copays ranging from $15 to $20 with no coinsurance, telehealth is available with a $0 to $50 copay and 20% coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Aetna Medicare Prime Chronic Care (HMO C-SNP) plan, with most covered benefits—including annual physical exams, health education, fitness benefits, and screenings—available with no copay and no coinsurance. Kidney disease education services are covered with no copay but require a 20% coinsurance, while several supplemental benefits like in-home safety assessments, personal emergency response systems, and nutritional counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), offering Medicare-covered exams for a $20 copay and no coinsurance, and annual 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 and no coinsurance, but OTC hearing aids, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers vision services with no coinsurance, offering routine eye exams and follow-up diabetic eye exams at no copay, and Medicare-covered exams for up to a $15 copay. Covered eyewear, including lenses, frames, and contact lenses, has no copay and is subject to a combined maximum benefit of $175 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP), offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $15 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit, but other diagnostic dental, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics 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, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers medical equipment with no copays across all categories, though prior authorization is required. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices require a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $20 copay for procedures, while radiological services include no copay for diagnostic radiology, a $20 copay with coinsurance for X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance, although 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, as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all excluded. Although the plan technically features no copay and no coinsurance for this benefit, none of these specific rehabilitation services are covered in practice.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Prime Chronic Care (HMO C-SNP) with no copay and no coinsurance, featuring a $30 monthly reimbursement for over-the-counter (OTC) items, annual wellness exams, and additional colorectal cancer screenings. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this benefit.
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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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