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Aetna Medicare Prime Chronic Total (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Chronic Total (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 Total (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Chronic Total (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 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 Prime Chronic Total (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 Total (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 Total (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 Total (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.90. 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:
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Drug Coverage
The Aetna Medicare Prime Chronic Total (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic medications when filled through standard pharmacies or standard mail order. This cost-sharing benefit applies to one-month, two-month, and three-month supplies. For higher-tier medications, costs are based on a percentage of the drug price. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 25% coinsurance for all supply durations at standard pharmacies and standard mail order. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Prime Chronic Total (HMO C-SNP) plan offers comprehensive health coverage with a strong focus on minimizing out-of-pocket costs. Members enjoy no copays for primary care visits, home health care, and diagnostic radiology services, while outpatient hospital services feature no copays and a 0% to 20% coinsurance. For inpatient care, there is a $2,230 copay per acute stay, while emergency care has a $115 copay that is waived if you are admitted. This plan also includes robust dental, vision, and hearing benefits to support your everyday wellness. You will pay no copay for dental services up to a $2,500 annual limit, and receive a $350 yearly allowance for covered eyewear. Additionally, the plan provides up to $500 per ear annually for prescription hearing aids and a $90 monthly allowance for over-the-counter health items.
Inpatient Hospital See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $2,230 copayment per stay and psychiatric stays require a $2,080 copayment per stay, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by the Aetna Medicare Prime Chronic Total (HMO C-SNP) feature no copays, but require a 0% to 20% coinsurance for outpatient hospital and ambulatory surgical center services, and a 20% coinsurance for outpatient substance abuse services. Outpatient blood services are covered with no copay and no coinsurance, while prior authorization is required for most other outpatient benefits.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Prime Chronic Total (HMO C-SNP) with a copay of either $55.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $115 copay and no coinsurance, while worldwide emergency transportation is covered with a 20% coinsurance and no copay, up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Other medical services, including specialist visits, mental health, and physical therapies, are covered with no copay and 0% to 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Prime Chronic Total (HMO C-SNP), with no copay and no coinsurance for annual physicals, fitness benefits, and health education, while kidney disease education and diabetes training require no copay and a 20% coinsurance. Sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Prime Chronic Total (HMO C-SNP) with no deductible, offering Medicare-covered exams and fitting evaluations with no copay, and routine exams with a 20% coinsurance and no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, 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 Total (HMO C-SNP) with no deductible, offering routine and follow-up diabetic eye exams with no copay and no coinsurance to 20% coinsurance. Covered eyewear, including contact lenses, eyeglasses, frames, and upgrades, has no copay and no coinsurance up to a combined maximum plan benefit of $350 every year.
Dental Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) offers partially covered dental services, featuring Medicare-covered dental services with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $2,500 annual maximum. While most preventive, diagnostic, and restorative services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Prime Chronic Total (HMO C-SNP) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Prime Chronic Total (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Prime Chronic Total (HMO C-SNP) with no copay, though coinsurance ranges from no coinsurance up to 20% depending on the item. This benefit covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers diagnostic and radiological services with prior authorization, featuring no copays for all covered services. There is no coinsurance for diagnostic procedures, lab services, and diagnostic radiology, while therapeutic radiology and outpatient X-ray services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Prime Chronic Total (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers some Cardiac Rehabilitation Services, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered. Standard and intensive cardiac rehabilitation services carry no copay, while pulmonary and SET for PAD services require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days.
Other Services See details
Aetna Medicare Prime Chronic Total (HMO C-SNP) partially covers other services with no copay and no coinsurance, including over-the-counter items up to $90 per month, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered.
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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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