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Aetna Medicare Partial Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial 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 Partial Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial 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 Partial 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 Partial 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 Partial 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 Partial Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.60. 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 Partial Dual Care (HMO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-month, two-month, or three-month supplies at standard pharmacies and standard mail-order services. Tier 2 generic drugs require a copayment of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for standard pharmacy and standard mail-order fills. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Partial Dual Care (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for primary care, specialist visits, home health, and skilled nursing facility stays. For inpatient hospital stays, members pay a $1,650 copay per stay, while emergency room visits carry a $110 copay that is waived upon admission. Most outpatient services, diagnostic tests, and dialysis require no copay but are subject to a 20% coinsurance. This plan also includes valuable supplemental benefits such as dental care with no copay or coinsurance up to a $1,250 annual limit, and routine hearing exams with a $2,000 hearing aid allowance per ear. Vision care features no deductibles and no copay, including a $300 annual eyewear allowance. Additionally, members benefit from up to 24 free one-way transportation trips per year and a $90 monthly over-the-counter allowance.
Inpatient Hospital See details
Aetna Medicare Partial Dual Care (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with a $1,650 copayment per stay and no coinsurance, though prior authorization is required. While unlimited additional days are covered for acute care at no extra cost, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers outpatient services with no copays, though coinsurance requirements apply to certain services. Outpatient hospital and ambulatory surgical center services have no copay and range from no coinsurance to 20% coinsurance, while outpatient substance abuse and blood services feature no copay and 20% coinsurance.
Partial Hospitalization See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers emergency services with a $110 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care requires a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers primary care, specialist, mental health, physical therapy, podiatry, and telehealth services with no copay and no coinsurance. Chiropractic services are not covered under this plan.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), offering no copay and no coinsurance for annual physical exams and select supplemental benefits, while kidney education and other screenings require a 20% coinsurance and no copay. Services not covered by this plan 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-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers routine hearing exams with no copay and 20% coinsurance, as well as fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 maximum per ear annually, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers vision services with no deductibles, featuring routine eye exams and contact lenses with no copay and a 20% coinsurance. Diabetic eye exams, eyeglasses, lenses, frames, and upgrades have no copay and no coinsurance, with a combined maximum eyewear benefit of $300 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), featuring Medicare-covered dental with no copay and a 20% coinsurance, and other dental services with no copay, no coinsurance, and a $1,250 annual maximum. While many preventive and comprehensive services are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Part B chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Partial Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers medical equipment with no copay, though a 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic shoes. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Partial Dual Care (HMO D-SNP) with prior authorization required and no copayments. Members pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Aetna Medicare Partial Dual Care (HMO D-SNP) plan with no copay. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Partial Dual Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. Standard Medicare-covered days are covered without requiring a prior three-day hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance, which includes a $90 monthly over-the-counter reimbursement, chronic illness meal benefits, and select wellness and cancer screenings. Acupuncture and highly integrated services for dual-eligible SNPs are not covered under this benefit.
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