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Aetna Medicare Preferred (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred (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 Preferred (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Fresno and Kern Counties. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Preferred (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 Preferred (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 Preferred (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 Preferred (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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $589.00 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 Preferred (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $589.00. After the deductible, you pay 25% coinsurance for all drugs in the initial coverage phase. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Preferred (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services and partial hospitalization have a coinsurance. Emergency services have copays, and primary care, preventive services, and vision services have no copays, while hearing and dental services have varying coinsurance. This plan provides coverage for ambulance and transportation services, with no copay for transportation to health-related locations. The plan also includes benefits for home health services, medical equipment, and other services like acupuncture and over-the-counter items with no copay. However, some services like cardiac rehabilitation and additional days for certain stays are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a copay of $2,185 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $2,036 per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days 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 services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. Individual and group sessions for outpatient substance abuse services also have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, with up to 40 one-way trips per year via rideshare services, bus/subway, or medical transport; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Preferred (HMO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay, and there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Preferred (HMO D-SNP) plan covers primary care services with no copay. Chiropractic services, occupational therapy services, and physical therapy/speech-language pathology services are covered with 20% coinsurance. Physician specialist services, additional telehealth benefits, and other health care professional services are covered with no copay. Mental health and psychiatric services have 20% coinsurance. Podiatry services have 20% coinsurance for routine foot care, and no copay. Opioid treatment program services also have 20% coinsurance.
Preventive Services See details
The Aetna Medicare Preferred (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with varying copays depending on the service. 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 exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with a coinsurance of at most 20% for routine hearing exams and no copay. Prescription hearing aids (all types) are covered with no copay, but inner ear, outer ear, and over the ear prescription hearing aids 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 have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum benefit of $200 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, while other services are partially covered. Oral exams, restorative services, adjunctive general services, prosthodontics (removable and fixed) are covered with no copay, while dental x-rays, prophylaxis (cleaning), fluoride treatment, endodontics, periodontics, maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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 Preferred (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies and Diabetic Equipment, both with 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered under the Aetna Medicare Preferred (HMO D-SNP) plan, but prior authorization and doctor referrals are required for some services. Diagnostic procedures/tests, lab services, therapeutic radiological services, and outpatient X-ray services have a coinsurance of up to 20%, while diagnostic radiological services have a coinsurance of at most 0%.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Preferred (HMO D-SNP) with no copay and no coinsurance. 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 Preferred (HMO D-SNP) plan. A doctor referral is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays. Prior authorization is required, and the cost-sharing information is not provided.
Other Services See details
The Aetna Medicare Preferred (HMO D-SNP) plan covers acupuncture, over-the-counter items, and a meal benefit. Acupuncture has no copay, and over-the-counter items have no copay up to $50 monthly. The meal benefit also has no copay. Several other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, private duty nursing, and others, are not covered.
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