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Aetna Medicare Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southwest Missouri. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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:
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Drug Coverage
The Aetna Medicare Dual (HMO D-SNP) plan features an annual drug deductible of $615. For prescription drugs, this plan offers savings with no copay for Tier 1 preferred generics and Tier 2 generics filled through standard pharmacies or standard mail order. This $0 cost sharing applies to one-month, two-month, and three-month supplies, helping you save on everyday maintenance medications. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance for standard pharmacy and mail order fills. These coinsurance rates apply to one, two, or three-month supplies, except for Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual (HMO D-SNP) offers comprehensive medical coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies to these outpatient and specialist services. Inpatient hospital stays require a copay of $2,150 for acute stays and $2,080 for psychiatric stays with no coinsurance. Emergency care is covered with a $115 copay, which is waived if you are admitted, while urgently needed services require a $40 copay. For dental, vision, and hearing, the plan provides preventive and comprehensive dental care up to a $2,000 annual limit with no copay or coinsurance, alongside a $1,500 annual hearing aid allowance per ear. Vision benefits include covered exams and a $250 annual eyewear allowance, though routine exams and contacts require a 20% coinsurance. Members also receive a $225 monthly reimbursement for over-the-counter items and have no copay or coinsurance for home health services.
Inpatient Hospital See details
Aetna Medicare Dual (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,150 copay per acute stay and a $2,080 copay per psychiatric stay. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual (HMO D-SNP) outpatient services are covered with no copay and a 20% coinsurance, which includes outpatient hospital care, ambulatory surgical center visits, substance abuse therapy, and blood services. 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 under the Aetna Medicare Dual (HMO D-SNP) plan, with prior authorization required. Depending on the service, you will pay either no copay and a 20% coinsurance, or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. While transportation services are technically listed as covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Dual (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum.
Primary Care See details
Aetna Medicare Dual (HMO D-SNP) covers primary care, specialist, mental health, and psychiatric services with no copays and up to 20% coinsurance, while chiropractic services are not covered. Occupational, physical, speech therapy, and telehealth benefits are covered with no copays and no coinsurance, while routine podiatry is limited to 12 annual visits with no copay and a 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual (HMO D-SNP), featuring no copay and no coinsurance for annual physical exams and select wellness programs, while kidney disease education and various screenings require a 20% coinsurance and no copay. Sub-services not covered under this benefit include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual (HMO D-SNP) covers hearing services with no deductible, featuring one annual routine exam with a 20% coinsurance and no copay, and one fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,500 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services covered by Aetna Medicare Dual (HMO D-SNP) require no deductible and feature no copay or coinsurance for Medicare-covered eye exams, follow-up diabetic exams, and eyeglasses. Routine eye exams (one per year) and contact lenses are covered with a 20% coinsurance and no copay, with a combined annual eyewear maximum of $250.
Dental Services See details
Aetna Medicare Dual (HMO D-SNP) partially covers dental services, offering a $2,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a 20% coinsurance and no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other infusion drugs require 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual (HMO D-SNP) covers medical equipment with no copays, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copay. There is a 20% coinsurance for lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
The Aetna Medicare Dual (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Dual (HMO D-SNP) with no copay, but only some services are covered in practice. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance and Medicare-defined copayments, though additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, but patients can be admitted without a prior three-day inpatient hospital stay.
Other Services See details
Other services are partially covered by Aetna Medicare Dual (HMO D-SNP) with no copay and no coinsurance for covered benefits, which include up to 12 acupuncture treatments yearly, chronic illness meals, and a $225 monthly over-the-counter reimbursement. Wellness exams, screening mammographies, and additional gFOBT and FIT screenings are also covered with no copay and no coinsurance, while highly integrated dual eligible services are not covered.
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