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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 Kansas City Metro Area. 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 $40.50. 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 $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. If you qualify for the low-income subsidy, the plan's premium may be reduced. During the initial coverage phase, after you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1925 copay per admission, while outpatient services, partial hospitalization, and ambulance services have 20% coinsurance. Emergency services have copays, with worldwide emergency services having no copay. This plan includes primary care with 20% coinsurance, and preventive services with no copay for an annual physical exam. Hearing exams and hearing aids are covered, with vision and dental services available. Additional benefits include home health services with no copay, and home infusion and dialysis services with cost-sharing. Other services like acupuncture and over-the-counter items are also covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. The copay for a Medicare-covered stay is $1925 per admission or stay, and additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a 20% coinsurance, and observation services with a 20% coinsurance. This plan also covers ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services with 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 by Aetna Medicare Assure (HMO D-SNP), including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay for up to 12 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Aetna Medicare Assure (HMO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Assure (HMO D-SNP) plan covers primary care services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, but routine care is not covered. Occupational therapy, physical therapy, and speech-language pathology services are covered with no copay and no coinsurance. Physician specialist services and mental health specialty services have a 20% coinsurance. Podiatry services have a 20% coinsurance with routine foot care and may have a copay, but Medicare-covered podiatry services have no copay. Other health care professional services, psychiatric services, and opioid treatment program services have a 20% coinsurance. Additional telehealth benefits are covered with no copay.
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 include coverage for health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices and modifications, with varying copays. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered with a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with no copay up to a maximum of $2500 per year, while OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, with routine eye exams having no copay, and other eye exam services having no copay. Eyewear has a 20% coinsurance, and a combined maximum plan benefit coverage of $350 per year, with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades having no copay.
Dental Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services and a $2,500 annual maximum for other dental services. Oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but some have visit limits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Assure (HMO D-SNP) plan. 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 are covered under the Aetna Medicare Assure (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Assure (HMO D-SNP) plan, including all diagnostic services, lab services, and radiological services. There is no copay for any of these services, but you may have to pay coinsurance of up to 20% for diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services.
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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is coinsurance for these services, as detailed in the plan documents.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF stays, nor does it cover non-Medicare-covered SNF stays.
Other Services See details
Other Services covered by the Aetna Medicare Assure (HMO D-SNP) plan include acupuncture with no copay, over-the-counter items with no copay up to $200 per month, and a meal benefit with no copay for chronic illnesses. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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