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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 2026, 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 out of 5 stars in 2026.
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 $9.50. 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 $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 Dual Prime (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one, two, or three-month fills at standard pharmacies and through standard mail order. Tier 2 generic medications require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty medications, costs are structured as coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also have a 25% coinsurance, which is limited to a one-month supply at standard pharmacies or mail order.
Additional Benefits
The Aetna Medicare Dual Prime (HMO D-SNP) offers comprehensive medical coverage with many services requiring no copay, though a standard 20% coinsurance applies to primary care, specialist visits, outpatient services, and durable medical equipment. Inpatient hospital stays require a set copayment per stay with no coinsurance, while skilled nursing facility stays feature no copay for the first 20 days. Emergency care is accessible with a flat copay, which is waived if you are admitted, alongside covered urgent care and worldwide emergency benefits. This plan provides robust supplemental benefits, including dental care up to a $3,000 annual limit and vision coverage with a $275 yearly allowance for eyewear. Members also benefit from a $1,000 annual allowance per ear for hearing aids and up to 36 one-way trips per year for plan-approved transportation with no copay or coinsurance. Additionally, the plan features a $125 monthly over-the-counter reimbursement and no copay or coinsurance for home health services.
Inpatient Hospital See details
Aetna Medicare Dual Prime (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $1,535 copayment per stay for acute care and a $1,540 copayment per stay for psychiatric care. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Aetna Medicare Dual Prime (HMO D-SNP) outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, are covered with no copay and a 20% coinsurance. Prior authorization is required for most outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Dual Prime (HMO D-SNP) plan with prior authorization, requiring either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Prime (HMO D-SNP), requiring a 20% coinsurance and no copay for both ground and air ambulance transport. Transportation benefits are partially covered with no copay and no coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Prime (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 up to a $250,000 maximum plan benefit with no copays and no coinsurance.
Primary Care See details
Primary care benefits under the Aetna Medicare Dual Prime (HMO D-SNP) generally feature no copay and a 20% coinsurance for services including primary care, specialist visits, physical therapy, and mental health. While some chiropractic services are covered, routine and other chiropractic services are not covered, and additional telehealth benefits are available with no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Prime (HMO D-SNP), featuring no copays or coinsurance for annual physicals and select supplemental benefits, but requiring a 20% coinsurance and no copay for kidney disease education and other screenings. Sub-services not covered 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
Hearing services are partially covered by Aetna Medicare Dual Prime (HMO D-SNP) with no deductibles, featuring routine hearing exams for a 20% coinsurance and no copay, alongside fitting evaluations and Medicare-covered exams for no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Prime (HMO D-SNP) with no deductibles, offering covered eye exams and eyewear with no copays, though a 20% coinsurance applies to routine exams and contact lenses. The plan includes one routine exam annually and a $275 combined maximum yearly benefit for eyewear, including glasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Dual Prime (HMO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual maximum. However, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Prime (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have 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 under the Aetna Medicare Dual Prime (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Prime (HMO D-SNP) with no copays and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Prime (HMO D-SNP) with prior authorization required. There is no copay for these services, and while diagnostic radiological services have no coinsurance, diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Prime (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Dual Prime (HMO D-SNP) with no copay, although only some services are covered. 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 Dual Prime (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Dual Prime (HMO D-SNP), offering meal benefits for chronic illness, wellness exams, and a $125 monthly over-the-counter reimbursement with no copay and no coinsurance. Acupuncture and certain other services are not covered under this benefit.
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