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Aetna Medicare Dual Preferred (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual 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 Dual Preferred (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (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 in GA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual 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 Dual 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 Dual 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 Dual Preferred (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $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 Dual Preferred (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium will be $28. During the catastrophic coverage phase, after your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs, but you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, while many outpatient services, including emergency services and some primary care, have either a copay or coinsurance. This plan includes coverage for preventive, hearing, vision, and dental services with no copay for many services. Additionally, this plan covers ambulance, home health, and transportation services, and provides other benefits such as acupuncture, over-the-counter items, and meal benefits.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered, with prior authorization required. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2,185 per admission or stay, and for Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2,036 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a coinsurance of 0% to 20%, observation services with a 20% coinsurance, ambulatory surgical center services with a coinsurance between 0% and 20%, outpatient substance abuse services with a 20% coinsurance for both individual and group sessions, and outpatient blood services with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan with prior authorization required. You will pay 20% coinsurance for this benefit.
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 plan-approved health-related locations, which are limited to 36 one-way trips per year using 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 by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
Primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance, while Routine Chiropractic Care has no copay. Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a 20% coinsurance, and for Podiatry Services, Routine Foot Care has a 20% coinsurance and Medicare-covered podiatry services have no copay. Additional Telehealth Benefits have no copay, and Opioid Treatment Program Services have a 20% coinsurance.
Preventive Services See details
Preventive services include no copay for annual physical exams, while additional preventive services may have a copay. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a 20% coinsurance for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with no copay for prescription hearing aids (all types), but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, and other preventive services with no copay. Medicare dental services have a 20% coinsurance, and other dental services have a $3,000 maximum benefit per year. Restorative services, endodontics, periodontics, removable prosthodontics, fixed prosthodontics, and oral and maxillofacial surgery 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, with Durable Medical Equipment (DME) requiring a 20% coinsurance and Prosthetic Devices and Medical Supplies also requiring a 20% coinsurance. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%, and Therapeutic Radiological Services have a 20% coinsurance. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Preferred (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 under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. The plan does not cover any of the 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 under the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but prior authorization is required. This plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers acupuncture with no copay, but is limited to 20 treatments per year. Over-the-counter items and meal benefits are also covered with no copay, with the OTC benefit providing up to $175 per month. Other services like annual wellness exams are covered with no copay; however, many services under "Other Services" are not covered.
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