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 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 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail order for any supply up to three months. For brand-name and specialty medications, your costs are determined by 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 require a 25% coinsurance through standard pharmacies and standard mail order.
Additional Benefits
The Aetna Medicare Partial Dual Care (HMO D-SNP) offers robust coverage for essential medical services, featuring no copays or coinsurance for primary care, specialist visits, home health, and skilled nursing facility stays. Inpatient hospital stays require a $1,830 copayment per stay with no coinsurance, while outpatient services and diagnostic tests generally feature no copays and coinsurance of up to 20%. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgently needed services carry a $40 copay. This plan also includes valuable supplemental benefits with no copays for routine dental, vision, and hearing care, though annual coverage limits and some coinsurance costs apply. For instance, dental benefits cover preventive and comprehensive services up to $1,250 annually, while prescription hearing aids are covered up to $2,000 per ear. Additionally, members can utilize up to 24 one-way trips per year for plan-approved transportation at no cost.
Inpatient Hospital See details
Aetna Medicare Partial Dual Care (HMO D-SNP) inpatient hospital services are partially covered, featuring a $1,830 copayment per stay, no coinsurance, and prior authorization requirements. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers outpatient services with no copays, although prior authorization is required for most 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 have no copay and a 20% coinsurance.
Partial Hospitalization See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers partial hospitalization services with prior authorization required. Depending on the service, your cost-sharing will either be a 20% coinsurance with no copay, or a $110.00 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. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but 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 you are 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 copays and no coinsurance up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Partial Dual Care (HMO D-SNP) provides primary care, specialist, therapy, mental health, and telehealth services with no copay and no coinsurance. Up to 12 routine podiatry visits per year are also covered with no copay or coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney education and various screenings require no copay and 20% coinsurance. Sub-services not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission 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
Hearing services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no deductible, featuring one routine hearing exam per year with a 20% coinsurance and one fitting evaluation with no copay. Prescription hearing aids are covered up to $2,000 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
Aetna Medicare Partial Dual Care (HMO D-SNP) covers vision services with no deductibles, including one routine eye exam annually with no copay and a 20% coinsurance. Eyewear benefits, including eyeglasses and contact lenses, feature no copays—with a 20% coinsurance for contact lenses—up to a combined maximum plan coverage of $350 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Partial Dual Care (HMO D-SNP), featuring no copay and no coinsurance for preventive and comprehensive services up to a $1,250 annual limit. Medicare-covered dental services have no copay and a 20% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance with no copay, while Medicare Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance, while diabetic supplies feature no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Diagnostic radiological services feature no coinsurance, while diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% minimum coinsurance.
Home Health Services See details
Aetna Medicare Partial Dual Care (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Under the Aetna Medicare Partial Dual Care (HMO D-SNP), some Cardiac Rehabilitation Services are covered with no copay, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Partial Dual Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond those covered by Medicare 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, including chronic illness meals, select wellness exams, and a monthly over-the-counter allowance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and Other 3 services are not covered under this plan.
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