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Aetna Medicare Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Dual (HMO D-SNP) is a HMO D-SNP plan offered by Coventry Health Care of Nebraska, Inc. available for the 2026 plan year to people living in Northern Nevada. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual (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 (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 (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 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 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 Dual (HMO D-SNP)
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Drug Coverage
The Aetna Medicare Dual (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 medications filled at standard pharmacies or through standard mail order. This zero-dollar coverage applies to one-month, two-month, and three-month prescriptions. For brand-name and specialty medications, costs are based on a percentage of the drug cost rather than flat copays. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs. These coinsurance rates apply to standard pharmacy and mail-order fills, with specialty medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual (HMO D-SNP) offers comprehensive medical coverage where many routine services require no copay, though a standard 20% coinsurance typically applies. Outpatient services, specialist visits, and diagnostic tests feature no copay and a 20% coinsurance, while inpatient hospital stays require a $2,080 copay per stay. Skilled nursing facility care is also available with no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance. In addition to medical care, the plan provides strong supplemental benefits including dental, vision, and hearing coverage with low out-of-pocket costs. Members receive up to $3,000 annually for dental care and $1,000 per ear for prescription hearing aids with no copay, alongside a $250 annual eyewear allowance. The plan also features a $90 monthly over-the-counter allowance and up to 36 one-way routine transportation trips per year with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage under the Aetna Medicare Dual (HMO D-SNP) requires a $2,080 copayment per stay and features no coinsurance, with prior authorization required for both acute and psychiatric admissions. While unlimited additional days are covered for acute hospital stays, additional days for psychiatric stays, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Outpatient services covered by Aetna Medicare Dual (HMO D-SNP) feature no copay and a 20% coinsurance, with prior authorization required for most services. Covered benefits include outpatient hospital care, observation services, ambulatory surgical center visits, outpatient substance abuse treatment, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Dual (HMO D-SNP) with prior authorization, requiring either no copay and a 20% coinsurance, or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Plan-approved transportation services are partially covered, offering up to 36 one-way trips per year with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual (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. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum.
Primary Care See details
Aetna Medicare Dual (HMO D-SNP) covers primary care, specialist visits, therapy services, and mental health care with no copay and a 20% coinsurance, while telehealth benefits are available with no copay and no coinsurance. Routine podiatry is covered for up to 12 visits per year with a 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual (HMO D-SNP), offering an annual physical, health education, and fitness benefits with no copay and no coinsurance, while kidney education and select screenings require no copay and a 20% coinsurance. The plan does not cover sub-services such as in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional 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 (HMO D-SNP), offering routine exams with a 20% coinsurance and fitting evaluations with no copay. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear annually, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Dual (HMO D-SNP) covers vision services with no deductibles, offering annual routine eye exams with no copay and 20% coinsurance, and follow-up diabetic exams with no copay and no coinsurance. Eyewear is covered with no copay up to a $250 annual limit, featuring no coinsurance for eyeglasses and 20% coinsurance for contact lenses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual (HMO D-SNP), offering a $3,000 annual limit on most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require no copay and a 20% coinsurance. However, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual (HMO D-SNP) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Aetna Medicare Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. There is a 20% coinsurance for lab services, diagnostic procedures, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services feature no coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Dual (HMO D-SNP) 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 (HMO D-SNP) with no copay; while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered in practice and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Dual (HMO D-SNP) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual (HMO D-SNP) offers partially covered other services with no copay and no coinsurance, including a $90 monthly over-the-counter allowance, chronic illness meals, annual wellness exams, and additional colorectal cancer screenings. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and Other 3 services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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