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Aetna Medicare Dual Extra Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra 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 Extra Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across GA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra 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 Extra 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 Extra 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 Extra Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.40. 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 Extra Care (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month, two-month, or three-month supplies at standard pharmacies and standard mail order. This provides significant savings on common maintenance medications. For brand-name and specialty drugs, cost-sharing is based on coinsurance rather than a flat copay. Tier 3 preferred brands require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance for standard pharmacy and mail order fills. Please note that Tier 5 specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) plan offers comprehensive medical coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies. Inpatient hospital stays require a copay of $2,000 for acute care or $2,070 for psychiatric care, while skilled nursing facilities offer no copay for the first 20 days. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care services require a $40 copay. This plan also features robust supplemental benefits, including up to $2,500 annually for preventive and comprehensive dental care and a $300 annual allowance for eyewear with no copays. Additionally, members benefit from no copays on routine hearing exams, up to $1,250 annually for prescription hearing aids, and 24 free one-way routine transportation trips. Other valuable daily perks include a $130 monthly over-the-counter allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) provides partially covered inpatient hospital services with no coinsurance, requiring a $2,000 copay per stay for acute care and a $2,070 copay per stay for psychiatric care with prior authorization. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers outpatient services with no copay, though prior authorization and coinsurance may apply. Covered benefits, including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services, feature no copay and coinsurance ranging from 0% to 20%.
Partial Hospitalization See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. For these services, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with a $115 copay and no coinsurance, with the copay 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 up to a $250,000 maximum limit with no copays and no coinsurance.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth benefits have no copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), featuring no copay and no coinsurance for annual physical exams, and no copay with a 20% coinsurance for kidney disease education and glaucoma 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 covered by Aetna Medicare Dual Extra Care (HMO D-SNP) include routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 annual limit, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductible, offering routine and follow-up diabetic eye exams with no copay, although routine exams require a 20% coinsurance. Eyewear is also covered up to a $300 annual maximum with no copay for glasses and upgrades, while contact lenses carry a 20% coinsurance.
Dental Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers dental services, offering preventive and comprehensive dental care with no copay and no coinsurance up to a $2,500 annual maximum, while Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra 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 drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers medical equipment with no copay, although prior authorization is required. Durable medical equipment, medical supplies, and prosthetics have a coinsurance of 0% to 20%, while diabetic supplies have no coinsurance and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Lab services and diagnostic radiological services feature no coinsurance, while diagnostic procedures, therapeutic radiological services, and outpatient X-rays carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) provides Cardiac Rehabilitation Services with no copay, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, 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 Extra Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) provides coverage with no copay and no coinsurance for acupuncture (up to 20 treatments per year), chronic illness meals, wellness exams, and a $130 monthly over-the-counter allowance. This benefit is partially covered, as Dual Eligible SNPs with Highly Integrated Services and certain other services are not covered.
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