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Aetna Medicare Assure Premier (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Premier (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 Assure Premier (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Premier (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Colorado. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Premier (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 Assure Premier (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 Assure Premier (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 Assure Premier (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.20. 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 Assure Premier (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy you use, but these costs are not specified in the provided information. If you qualify for the low-income subsidy (LIS), you'll pay $25.20 per month for Part D. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure Premier (HMO D-SNP) plan offers a range of benefits with varying cost-sharing structures. Many services, including primary care, hearing exams, and vision services, come with a 20% coinsurance. Emergency services have a $110 copay, while urgent care has a $45 copay. The plan also includes benefits like preventive services, home health services, and OTC items with no copay. This plan provides coverage for inpatient hospital stays, outpatient services, and partial hospitalization with copays or coinsurance depending on the service. It also covers ambulance and transportation services, with a 20% coinsurance for ambulance services and no copay for transportation to health-related locations. Dental services, hearing aids, and medical equipment are also covered, each with their own cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, the copay is $2160 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036 per admission or stay; Additional Days for Inpatient Hospital-Acute has no copay.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services and Observation Services have a 20% coinsurance, and Outpatient Blood Services also has a 20% coinsurance. Individual and Group Sessions for Outpatient Substance Abuse have a coinsurance between 20% and 20%.
Partial Hospitalization See details
Aetna Medicare Assure Premier (HMO D-SNP) covers partial hospitalization with a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered, with a 20% coinsurance for both ground and air ambulance services, and no copay for transportation services to a plan-approved health-related location. Transportation services to any health-related location are not covered, and transportation services to a plan-approved health-related location are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Assure Premier (HMO D-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure Premier (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. Many services have a 20% coinsurance, while additional telehealth benefits have no copay.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional preventive services are covered, but some services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and over-the-counter hearing aids. Hearing exams have a 20% coinsurance for routine hearing exams, and no copay for Medicare-covered benefits, and fitting/evaluation for hearing aid. Prescription hearing aids have no copay, and a maximum plan benefit coverage of $2000 per year. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Assure Premier (HMO D-SNP) plan covers vision services, including eye exams with 20% coinsurance, and eyewear with 20% coinsurance and a $400 combined maximum benefit. Routine eye exams and other eye exam services have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
Dental services are covered with a 20% coinsurance, and other dental services have a maximum plan benefit coverage of $2,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and restorative services are covered with no copay. 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. 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 under the Aetna Medicare Assure Premier (HMO D-SNP) plan. You will pay 20% coinsurance for this service, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic, and radiological services. All diagnostic services, and outpatient X-ray services have a coinsurance of at most 20%, while diagnostic radiological services have a coinsurance of at most 20% with a minimum coinsurance of 0%. Therapeutic radiological services have a coinsurance of at most 20% with a minimum coinsurance of 20%. There is no copay for these services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Assure Premier (HMO D-SNP) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Premier (HMO D-SNP) plan. The plan does not cover any Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the copay information is not available. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Assure Premier (HMO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, and also covers Other 1 and Other 2 services with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, and Self-Directed Personal Assistance Services are not covered.
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