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Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full 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 Full Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 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 Full 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 Full 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 Full 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 Full Dual Care (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 $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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. Under this plan, beneficiaries pay no copay for Tier 1 preferred generic and Tier 2 generic drugs obtained through standard pharmacies or standard mail order. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance at standard pharmacies and mail-order services.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) offers comprehensive medical coverage, with many outpatient, diagnostic, and primary care services requiring no copay and a 20% coinsurance. Inpatient hospital stays carry a copay of $2,000 per stay with no coinsurance, while emergency care is available with a $115 copay. Skilled nursing facility care and home health services are also covered, featuring no copays for early treatment periods. Supplemental benefits are a major highlight of this plan, featuring dental care with no copay or coinsurance up to a $4,500 annual limit. Members also enjoy no copay or coinsurance for prescription hearing aids up to $1,500 per ear, a $400 annual eyewear allowance, and up to 36 one-way transportation trips. To help with everyday health needs, the plan provides a $210 monthly over-the-counter allowance and telehealth services with no copay.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers inpatient acute hospital stays with a $2,000 copay per stay and psychiatric stays with a $2,070 copay per stay, both featuring no coinsurance and requiring prior authorization. While unlimited additional acute care days are covered with no copay, non-Medicare-covered stays, psychiatric additional days, and room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Aetna Medicare Full Dual Care (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation is partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers partially covered primary care benefits with no copay and a 20% coinsurance for most services, including primary care, specialists, therapies, and mental health. While routine chiropractic and podiatry services are covered up to 12 visits per year with no copay and a 20% coinsurance, other chiropractic services are not covered, and telehealth services are available with no copay and no coinsurance.
Preventive Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) offers preventive services with no copay and no coinsurance for annual physical exams and select supplemental benefits, while other services like kidney disease education and glaucoma screenings require a 20% coinsurance and no copay. This benefit is partially covered, as several options including in-home support, weight management, alternative therapies, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no deductible, including 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 $1,500 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers vision services with no deductible, offering routine eye exams with no copay and a 20% coinsurance. Covered eyewear features no copay and a $400 annual maximum, though contact lenses are subject to a 20% coinsurance and no copay.
Dental Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) provides partially covered dental services with no copay and no coinsurance up to a $4,500 annual limit, though Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full 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 drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, diabetic supplies have no coinsurance, and prosthetic devices and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required before you can receive this care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay under the Aetna Medicare Full Dual Care (HMO D-SNP) plan, but in practice, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers other services with no copay and no coinsurance, providing benefits such as a $210 monthly over-the-counter allowance, chronic illness meals, and annual wellness exams. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and certain other services are not covered under this plan.
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