A non-government entity
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 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 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 $4.80. 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:
Sign up for Aetna Medicare Partial Dual Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Partial Dual Care (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order. For Tier 2 generic medications, standard pharmacy and mail order costs are a $10 copay for a 1-month supply, $20 for a 2-month supply, and $30 for a 3-month supply. For brand-name and specialty medications, costs shift to a coinsurance model under this plan. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs through standard pharmacy or mail order. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The Aetna Medicare Partial Dual Care (HMO D-SNP) plan provides robust medical coverage with no copays and no coinsurance for primary care, specialist visits, home health, and skilled nursing facility services. For inpatient hospital stays, members pay a $1,650 copayment per admission with no coinsurance, while outpatient treatments, diagnostics, and dialysis generally require no copays and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived upon admission, and urgent care has a $40 copay. Supplemental coverage includes routine dental, vision, and hearing care, which offer no copays and up to a 20% coinsurance, alongside a $275 annual eyewear allowance and a $1,250 annual dental limit. Furthermore, the plan features up to 24 free one-way transportation trips per year, a $75 monthly over-the-counter allowance, and fitness benefits with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Partial Dual Care (HMO D-SNP) partially covers inpatient hospital services, requiring a $1,650 copayment per admission and no coinsurance for Medicare-covered acute and psychiatric stays, with prior authorization required. While unlimited additional acute care days are covered with no copay, additional psychiatric days, room 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 prior authorization is required for most treatments. Covered benefits, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, feature coinsurance ranging from 0% to 20% with no deductibles.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with prior authorization required. Cost-sharing for these services is either a 20% coinsurance with no copay, or a $110 copay with 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, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Partial Dual Care (HMO D-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, urgent, and transportation services are also covered with no copay and no coinsurance up to a maximum benefit of $250,000.
Primary Care See details
Aetna Medicare Partial Dual Care (HMO D-SNP) provides primary care, specialist visits, physical and occupational therapy, mental health, podiatry, and telehealth services with no copay and no coinsurance. While chiropractic services are not covered under this plan, other covered benefits like psychiatric and opioid treatment services also feature no copay and no coinsurance, though prior authorization may be required.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), offering annual physical exams, health education, and fitness benefits with no copay and no coinsurance, while kidney disease education and other select screenings have no copay but a 20% coinsurance. Several sub-services are not covered under this plan, including medical nutrition therapy, weight management programs, alternative therapies, and in-home safety assessments.
Hearing Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) hearing services are partially covered with no deductible, offering annual routine exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear yearly with no copay and no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no deductibles and no copays, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan covers one routine eye exam annually and offers up to a $275 yearly allowance for eyewear, including eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other dental services up to a $1,250 annual limit. The benefit is partially covered, as 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, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Partial Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
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 copays. Members will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services have 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
Aetna Medicare Partial Dual Care (HMO D-SNP) offers some covered Cardiac Rehabilitation Services with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. This benefit does not require a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a chronic illness meal benefit, annual wellness exams, additional colon cancer screenings, and a $75 monthly reimbursement for over-the-counter items.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved