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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (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 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 Dual Care (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using a standard pharmacy or standard mail order for one, two, or three-month supplies. This provides cost-effective access to essential everyday medications. For brand-name and specialized medications, costs are structured as coinsurance. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications require a 25% coinsurance through standard pharmacies and mail order. Coinsurance rates apply to all available supply lengths, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) offers comprehensive medical coverage, with many outpatient, primary care, and specialist services requiring no copay and a 20% coinsurance. Inpatient hospital stays require a set copayment per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Standard home health care and skilled nursing facility services are also fully covered with no copay and no coinsurance. This plan features valuable supplemental benefits, including up to $2,000 annually for dental care and up to $1,500 per ear for hearing aids with no copays. Additionally, members receive a $250 annual eyewear allowance and a $200 monthly over-the-counter reimbursement allowance, both with no copays.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute hospital stays with a $2,230 copayment per stay and inpatient psychiatric stays with a $2,080 copayment per stay, both featuring no coinsurance. Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient services, including hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Dual Care (HMO D-SNP), with prior authorization required. Depending on the service, you will either pay a $110.00 copay with no coinsurance, or no copay with a 20% coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care, specialist, psychiatric, mental health, and opioid treatment services with no copay and 20% coinsurance, while physical, occupational, speech, and telehealth therapies have no copay and no coinsurance. Routine podiatry is covered for up to 12 visits per year with no copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers preventive services, offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and other screenings carry no copay and a 20% coinsurance. Multiple sub-services are not covered under this plan, including weight management, in-home support, nutritional/dietary benefits, alternative therapies, and counseling.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers hearing services, including routine 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, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no deductible, including one routine eye exam per year with a 20% coinsurance and no copay. Covered eyewear is subject to a $250 annual maximum, offering contact lenses with a 20% coinsurance and no copay, alongside eyeglasses and frames with no copay.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), offering up to $2,000 annually for preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental services require no copay and a 20% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts require a 20% coinsurance, while diabetic supplies from specified manufacturers are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Medicare-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 under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Dual Care (HMO D-SNP) with no copay, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 Dual Care (HMO D-SNP) with no copay and no coinsurance, though additional days beyond Medicare coverage are not covered. Prior authorization is required, but the plan does not require a three-day inpatient hospital stay prior to admission.
Other Services See details
Other Services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance, including up to 12 annual acupuncture treatments, chronic illness meals, and a $200 monthly over-the-counter reimbursement allowance. While additional wellness exams and screenings are also covered, highly integrated services for dual eligible SNPs and certain other services are not covered.
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