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Aetna Medicare Dual Prime (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Prime (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 Dual Prime (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Prime (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Prime (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 Dual Prime (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 Dual Prime (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 Dual Prime (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.50. 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 $590.00 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 $9350.00 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 Dual Prime (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. The plan's premium may be reduced if you qualify for the low-income subsidy, with the cost of the Part D premium being $16.50.
Additional Benefits
The Aetna Medicare Dual Prime (HMO D-SNP) plan provides comprehensive coverage, including inpatient hospital stays with a $1540 copay per admission, and outpatient services with a 20% coinsurance. It also offers a range of services with no copay, such as preventive services, additional telehealth benefits, and transportation to health-related locations (up to 40 one-way trips per year), as well as OTC items up to $105.00 per month. This plan includes vision, dental, and hearing services, with varying cost-sharing. Hearing exams and hearing aids have a $0 copay, and there is a $3,000 annual maximum for dental, with many dental services having no copay. Emergency services have a $110 copay, and urgent services have a $45 copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For each admission or stay, the copay is $1540.00 for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services, are covered with a 20% coinsurance. Outpatient Blood Services are also covered with a 20% coinsurance, and includes an enhanced benefit where the three (3) pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay and are limited to 40 one-way trips per year.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Dual Prime (HMO D-SNP) plan, with a $110 copay. Urgently needed services have a $45 copay, and worldwide emergency and urgent coverage have no copay.
Primary Care See details
The Aetna Medicare Dual Prime (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance, while additional telehealth benefits have no copay.
Preventive Services See details
The Aetna Medicare Dual Prime (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. This plan also covers several additional preventive services, such as health education and wigs for hair loss related to chemotherapy, with a $0 copay, and services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine exams, and a $0 copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a $0 copay for all types, with a maximum plan benefit of $2,000 per year, excluding inner ear, outer ear, and over-the-ear hearing aids which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, has a 20% coinsurance, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum benefit of $280 per year for all eyewear.
Dental Services See details
Dental services are covered, with a $3,000 annual maximum benefit, and include a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, Medical Supplies, Diabetic Equipment, Diabetic Supplies (no copay), and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Prime (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% (with a minimum of 0%), and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20% (with a minimum of 20%). There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Prime (HMO D-SNP) plan. Although the plan covers Cardiac Rehabilitation Services, the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the cost sharing includes a copay, with more details available in the plan documents.
Other Services See details
The Aetna Medicare Dual Prime (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with no copay, a maximum plan benefit coverage amount of $105.00 every month, and covers Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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