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Aetna Medicare Chronic Care (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Chronic Care (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Chronic Care (HMO C-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Chronic Care (HMO C-SNP) is a HMO C-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Select Counties in Atlanta Metro. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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 Chronic Care (HMO C-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:
Sign up for Aetna Medicare Chronic Care (HMO C-SNP)
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Drug Coverage
The Aetna Medicare Chronic Care (HMO C-SNP) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order, compared to a $2 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs carry a $5 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $12 copay. For brand-name and specialty medications, your costs are determined by coinsurance rather than flat copays. Tier 3 preferred brand drugs require 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance. These coinsurance rates apply across all preferred and standard retail pharmacies as well as mail-order services.
Additional Benefits
The Aetna Medicare Chronic Care (HMO C-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, preventive screenings, and home health care. Specialist visits feature copays ranging from no copay to $45, while inpatient hospital stays require daily copays for the first week before transitioning to no copays. Emergency care is covered with a $115 copay that is waived if admitted, and ground ambulance services require a $300 copay with no coinsurance. For supplemental care, the plan provides routine dental, vision, and hearing exams with no copay, alongside annual allowances of $150 for eyewear and up to $500 per ear for hearing aids. Preventive dental services are fully covered with no copay, while comprehensive dental care is covered up to a $2,000 annual limit with 20% to 50% coinsurance. Additionally, members receive a $30 monthly allowance for over-the-counter items and pay no copays for diagnostic lab services.
Inpatient Hospital See details
Aetna Medicare Chronic Care (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, subject to prior authorization. Acute stays require a $388 daily copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays incur a $346 daily copay for days 1 through 6 and no copay for days 7 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers outpatient hospital services with a $0 to $495 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 copays and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Chronic Care (HMO C-SNP) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Chronic Care (HMO C-SNP) 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 $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $300.
Primary Care See details
Aetna Medicare Chronic Care (HMO C-SNP) covers primary care and routine podiatry with no copay and no coinsurance, while specialist visits require a $0 to $45 copay and no coinsurance. Most therapies, psychiatric, and mental health services have copays of $35 to $40 with no coinsurance, and telehealth services carry a $0 to $45 copay with 20% coinsurance. For chiropractic services, some services are covered but routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services under the Aetna Medicare Chronic Care (HMO C-SNP) are partially covered, offering annual physical exams, health education, and select screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, but several additional services such as in-home safety assessments, medical nutrition therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services under the Aetna Medicare Chronic Care (HMO C-SNP) are partially covered, featuring routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no coinsurance and no deductible, offering routine and diabetic eye exams for no copay, and Medicare-covered exams with a copay of up to $45. Eyewear, including lenses, frames, and contact lenses, is also covered with no copay and no coinsurance up to a combined annual maximum of $150.
Dental Services See details
Dental services are covered by Aetna Medicare Chronic Care (HMO C-SNP), offering Medicare-covered dental for a $45 copay and no coinsurance, alongside preventive services like exams and cleanings with no copay and no coinsurance. Comprehensive services are partially covered up to a $2,000 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Chronic Care (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment benefits under the Aetna Medicare Chronic Care (HMO C-SNP) are covered with no copays, though coinsurance varies depending on the service. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices have a 20% coinsurance, and diabetic equipment and supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Chronic Care (HMO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures require a $0 to $20 copay with no coinsurance, lab services have no copay or coinsurance, and radiological services range from a $0 minimum copay for diagnostic imaging to a $20 copay for X-rays and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Chronic Care (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Chronic Care (HMO C-SNP) offers Cardiac Rehabilitation Services with no copay and no coinsurance. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Chronic Care (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Chronic Care (HMO C-SNP) partially covers other services, offering no copay and no coinsurance for covered benefits such as annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and over-the-counter (OTC) items. Eligible OTC items are covered with no copay or coinsurance up to $30 monthly via reimbursement, while acupuncture and meal benefits are not covered.
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