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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (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 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs. This savings applies to 1-month, 2-month, and 3-month supplies filled through standard pharmacies or standard mail order. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copayments. Tier 3 (Preferred Brand) drugs require a 22% coinsurance for standard pharmacy and standard mail order services. Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications both carry a 25% coinsurance, with Tier 5 coverage limited to a 1-month supply.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan covers essential medical services, featuring no copay for primary care, specialist visits, and outpatient hospital services, though these are typically subject to a 20% coinsurance. Inpatient hospital stays require a $1,970 copay per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Skilled nursing facility stays are covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. For routine wellness, the plan offers dental coverage with no copay and no coinsurance up to a $2,000 annual limit, alongside routine vision and hearing exams. Members also receive up to $1,500 per ear annually for prescription hearing aids and a $200 annual allowance for eyewear with no copay or coinsurance. Additional benefits include home health services and an $85 monthly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,970 copay per admission and no coinsurance, subject to prior authorization. Unlimited additional days are covered for acute stays with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copayments. A 20% coinsurance applies to these covered benefits, and prior authorization is required for outpatient hospital, ambulatory surgical, and substance abuse services.
Partial Hospitalization See details
Aetna Medicare Dual Care (HMO D-SNP) covers partial hospitalization services with no copay, though a 20% or 30% coinsurance applies and prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Care (HMO D-SNP) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no copay and no coinsurance.
Primary Care See details
Primary care, specialist, therapy, and mental health services under Aetna Medicare Dual Care (HMO D-SNP) are covered with no copay and 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Some chiropractic services are covered, though routine and other chiropractic services are not covered, and podiatry is covered with no copay and 0% to 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney education and other screenings require no copay and a 20% coinsurance. Excluded services include in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling.
Hearing Services See details
Hearing services covered under Aetna Medicare Dual Care (HMO D-SNP) include Medicare-covered exams and annual hearing aid fittings with no copay and no coinsurance, plus one routine exam per year with no copay and 20% coinsurance. Prescription hearing aids are partially covered up to $1,500 per ear annually with no copay or coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no deductibles, offering one routine eye exam per year and contact lenses with no copay and a 20% coinsurance. Follow-up diabetic eye exams, eyeglasses, and upgrades are covered with no copay and no coinsurance, with eyewear services subject to a combined $200 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance for most preventive and comprehensive care up to a $2,000 annual limit, though Medicare-covered dental services require a 20% coinsurance and no copay. Orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required for these benefits. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copays, though prior authorization is required. There is a 20% coinsurance for lab services, diagnostic procedures, 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 Dual Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Dual Care (HMO D-SNP) with no copay, but only some services are covered. Standard cardiac rehabilitation, intensive rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered days are not covered.
Other Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, providing a meal benefit for chronic illness, wellness exams, additional screenings, and up to $85 per month in over-the-counter item reimbursements. Acupuncture is not covered under this benefit.
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