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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 Augusta, Macon and South 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 $27.00. 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 you meet your deductible, your costs will vary depending on the specific drug tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D will be $27.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a wide range of benefits with varying costs. Inpatient hospital stays require a $1735 copay per admission, while outpatient services and many primary care services have a coinsurance, typically 20%. Emergency services have a copay, but urgent care and worldwide emergency services have no copay. Many services have no copay, including preventive services, routine eye exams, fitting/evaluation for hearing aids, and most dental services. The plan also includes coverage for hearing aids, vision, and dental services, with annual maximums for some benefits. Additionally, the plan offers coverage for ambulance and transportation services, along with home health services, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization, with a copay of $1735 per admission or stay for Medicare-covered stays, and no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay per day. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, including outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and ambulatory surgical center services with a coinsurance between 0% and 20%. Individual and group sessions for outpatient substance abuse have a 20% coinsurance, and outpatient blood services have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered. Ground and air ambulance services have a 20% coinsurance, while transportation services have no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; there is no coinsurance for either. Worldwide Emergency Services has a maximum plan benefit of $250,000, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
Primary Care Physician Services are covered with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, and routine care has no copay. Occupational Therapy, Physician Specialist, Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Mental Health and Psychiatric Services are covered with a 20% coinsurance for individual and group sessions. Podiatry Services include routine foot care with a 20% coinsurance and no copay. Other Health Care Professional services are covered with between 0% and 20% coinsurance. Additional Telehealth Benefits have no copay. Opioid Treatment Program Services are covered with a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services are covered, including Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications, with a $0 copay. 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 are covered with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum plan benefit of $500 per year, and all types of prescription hearing aids have no copay, while inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers vision services, including 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, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum benefit of $400 per year.
Dental Services See details
Dental services are covered, with a $3,000 maximum benefit per year and 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Dual Preferred (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Dual Preferred (HMO D-SNP), including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics and Medical Supplies with 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered, while Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
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%, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but the plan does not cover the specific sub-services. The plan does not have a copay, but there is coinsurance for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not provide SNF services as a supplemental benefit under Part C. Prior authorization is required.
Other Services See details
Other Services include acupuncture with no copay, and over-the-counter (OTC) items with no copay and a maximum benefit of $175.00 every month. The plan also covers a meal benefit with no copay, annual wellness exams, screening mammography, gFOBT, and FIT with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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