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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual 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 Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual 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 in 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 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 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 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 Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 Care (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 drugs filled at standard pharmacies or through standard mail order. For brand-name and specialty drugs, cost-sharing is structured as a percentage of the drug cost. 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.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan provides comprehensive coverage for essential healthcare needs with many services requiring no copay and no coinsurance. Members enjoy no copay for primary care visits, home health services, and routine preventive care, while specialist visits require a $30 copay. For hospital stays, inpatient acute care features a $407 copay for days one through six and no copay thereafter, while outpatient services range from no copay to a $450 copay. Supplemental benefits include routine dental, vision, and hearing care with no copay and no coinsurance, subject to plan allowance limits like $1,200 annually for dental services. Additionally, the plan offers valuable extras with no copay, such as a $50 monthly over-the-counter reimbursement, chronic illness meals, and acupuncture. For medical supplies and durable medical equipment, members pay no copay alongside a standard 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $407 copay for days 1 to 6, no copay for days 7 to 90, and no copay for unlimited additional days, while psychiatric stays require a $2,036 copay per stay. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient hospital services with a $0 to $450 copay and no coinsurance, and observation services with a $407 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $40 copay (no coinsurance) for individual sessions and 20% coinsurance (no copay) for group sessions.
Partial Hospitalization See details
Aetna Medicare Dual Care (HMO D-SNP) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ambulance services with a $280 copay and coinsurance for ground transport, and a copay plus 20% coinsurance for air transport. Transportation services are partially covered with no copay or coinsurance for up to 12 one-way trips per year to plan-approved locations, while trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Dual Care (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 $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum limit.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other benefits like physical therapy ($25 copay) and mental health ($40 copay) require no coinsurance, though chiropractic benefits are only partially covered because other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Dual Care (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, fitness benefits, and wellness programs, though kidney disease education carries a 20% coinsurance and no copay. Several services are not covered under this plan, including in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers hearing services, offering Medicare-covered exams for a $30 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered up to $1,250 per ear annually with no copay and no coinsurance, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no coinsurance and no deductibles, offering eye exams with a $0 to $30 copay and annual routine eye exams with no copay. Covered eyewear, including contacts, eyeglasses, frames, and upgrades, has no copay and is subject to a combined maximum plan benefit of $175 per year.
Dental Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with a $30 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $1,200 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers medical equipment with no copay, although prior authorization is required for these services. While diabetic supplies have no coinsurance, you will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have no coinsurance and a copay ranging from $0 to $95, lab services have no copay, outpatient X-rays have a $35 copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers Cardiac Rehabilitation Services with no coinsurance, and while some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other Services under the Aetna Medicare Dual Care (HMO D-SNP) are covered with no copay and no coinsurance, including up to 20 acupuncture treatments per year, a $50 monthly over-the-counter reimbursement, and chronic illness meal benefits. Additional wellness exams and screenings are also covered with no copay or coinsurance, though highly integrated services are not covered.
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