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Aetna Medicare Assure (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure (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 Assure (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Eastern Kansas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure (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 Assure (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 Assure (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 Assure (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.10. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 Assure (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. For example, inpatient hospital stays have a $1,870 copay, while emergency services have a $110 copay. Outpatient and primary care services typically have a 20% coinsurance. This plan also provides coverage for preventive services, hearing, vision, and dental care, with specific cost-sharing arrangements. You will find no copay for many services, including routine eye exams, preventive services, and over-the-counter items. Additionally, the plan includes benefits like transportation services, home health services, and home infusion bundled services, with specific cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered and require prior authorization, with a copay of $1,870 per admission or stay for Medicare-covered stays. 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 Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance, and outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure (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 are covered, with 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay for up to 6 one-way trips per year via rideshare services, bus/subway, or medical transport, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Services are covered with a $0 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care coverage includes 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. Primary Care Physician Services, Physician Specialist Services, Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services each have a 20% coinsurance. Chiropractic Services and Additional Telehealth Benefits have no copay. Podiatry Services has a 20% coinsurance for Routine Foot Care and no copay for Medicare-covered Podiatry Services. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with a $0 copay for Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, and Home and Bathroom Safety Devices. Other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% 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). However, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Assure (HMO D-SNP) covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and 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, up to a combined maximum of $400 per year.
Dental Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers dental services with a 20% coinsurance for Medicare Dental Services, and other dental services are covered up to a maximum of $2750 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment have no copay, while other services have visit limits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 under the Aetna Medicare Assure (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits with the Aetna Medicare Assure (HMO D-SNP) plan include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance. Diabetic Supplies have no coinsurance, and 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 Assure (HMO D-SNP) plan. Diagnostic procedures and lab services have a coinsurance of at most 20%, while diagnostic radiological services have no coinsurance 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 by the Aetna Medicare Assure (HMO D-SNP) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered or non-Medicare-covered stays. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers acupuncture with no copay, and up to 12 treatments per year. Over-the-counter items are covered with no copay, up to a maximum of $250 per month, including nicotine replacement therapy and Naloxone. The plan also covers meal benefits with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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