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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 Central 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 $51.70. 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 the deductible is met, you will pay the costs for your drugs, but the specific costs for each drug tier are not listed. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $51.70.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits, including inpatient and outpatient services, with varying cost-sharing. Inpatient hospital stays have a $2025 copay, while many outpatient services like primary care, vision, and hearing have coinsurance or no copay. Emergency services have a copay, and ambulance services have coinsurance, while transportation to a plan-approved location is covered with no copay. Preventive services, such as annual physical exams, have no copay, and hearing exams and hearing aids are covered. Dental services are covered with a $2,000 maximum benefit per year. The plan also covers home health services with no cost sharing, and offers additional benefits like over-the-counter items and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $2025 per admission or stay for Medicare-covered stays. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services, Individual Sessions for Outpatient Substance Abuse, and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance. Outpatient Blood Services have a 20% coinsurance.
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 a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, but with a limit of 6 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy, Physician Specialist Services, Mental Health, Podiatry, Other Health Care Professional, Psychiatric Services, Physical Therapy, Additional Telehealth, and Opioid Treatment Program Services, are covered. Primary Care Physician Services, Physician Specialist Services, Mental Health, Psychiatric Services, Physical Therapy, and Opioid Treatment Program Services have a 20% coinsurance, while Chiropractic Services and Additional Telehealth have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy are covered with no copay, while Kidney Disease Education Services, 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 and prescription hearing aids are covered by the Aetna Medicare Assure (HMO D-SNP) plan, while OTC hearing aids are not covered. Routine hearing exams have no copay and at most 20% coinsurance, and fitting/evaluation for hearing aids have no copay, while prescription hearing aids have no copay with a maximum plan benefit coverage of $2500 per year.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a 20% coinsurance, with routine eye exams and other eye exam services having no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, has a 20% coinsurance, with contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades having no copay, and a combined maximum benefit of $375 per year.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare dental services, and other dental services have a $2,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment have no copay, but oral exams are limited to 4 visits per year, dental x-rays are limited to 3, and prophylaxis (cleaning) is limited to 2. Other preventive dental services are covered with no copay. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay, but are limited to a certain number of visits per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits under the Aetna Medicare Assure (HMO D-SNP) plan include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered devices and supplies. Diabetic Supplies have no coinsurance, while 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, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. There is no copay for any of these services, but you may have to pay up to 20% coinsurance, depending on the specific service.
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 with prior authorization. The plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays; cost sharing 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, including nicotine replacement therapy and Naloxone, are covered with no copay, up to $240 per month. Meal benefits are covered with no copay. Other services include annual wellness exams, screening mammography, gFOBT, and FIT with no copay. 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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