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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 Metro St Louis-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 $35.20. 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) prescription drug plan features an annual drug deductible of $615. Fortunately, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This ensures that essential generic prescriptions are highly affordable with zero-dollar costs for one-month, two-month, and three-month supplies. For higher-tier medications, your out-of-pocket costs are determined by coinsurance rates rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance percentages apply to standard pharmacy and mail-order fills, with specialty tier medications limited to one-month supplies.
Additional Benefits
The Aetna Medicare Dual (HMO D-SNP) plan offers comprehensive coverage designed to minimize out-of-pocket costs, featuring no copays or coinsurance for preventive care, home health services, and skilled nursing facility stays. For routine medical needs, including primary care, specialist visits, outpatient services, and diagnostic tests, beneficiaries generally pay no copay alongside a standard twenty percent coinsurance. Major medical events require a two thousand eighty dollar copayment per inpatient hospital stay and a one hundred fifteen dollar copay for emergency room visits. Additionally, this plan provides valuable supplemental benefits to support overall well-being, including dental care up to a two thousand dollar annual limit and hearing aids up to one thousand five hundred dollars per ear with no copays. Vision care includes routine exams and up to a two hundred fifty dollar annual eyewear allowance with no copays. Members also benefit from a monthly two hundred twenty-five dollar over-the-counter reimbursement and covered home meal deliveries with no copays or coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Dual (HMO D-SNP) with a $2,080 copayment per stay and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, while unlimited additional acute days are covered with no copayment.
Outpatient Services See details
Aetna Medicare Dual (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
The Aetna Medicare Dual (HMO D-SNP) plan covers partial hospitalization services, which require prior authorization. Depending on the service, your costs will be either no copay with 20% coinsurance, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual (HMO D-SNP), requiring a 20% coinsurance and no copay for ground and air ambulance services with prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Dual (HMO D-SNP) plan with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 lifetime limit with no copay and no coinsurance.
Primary Care See details
Primary care benefits offered by Aetna Medicare Dual (HMO D-SNP) feature no copay and a 20% coinsurance for primary care, specialist, mental health, psychiatric, and opioid treatment services, though chiropractic services are not covered. Occupational, physical, and speech therapies, as well as telehealth, require no copay and no coinsurance, while podiatry is covered with no copay for Medicare-covered services and a 20% coinsurance for up to 12 routine visits annually.
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 Medicare-covered zero-dollar preventive services. While select supplemental benefits like fitness and health education are covered with no copay, other services like medical nutrition therapy and weight management are not covered, and specific screenings require a 20% coinsurance with no copay.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual (HMO D-SNP), featuring Medicare-covered exams and fitting evaluations with no copay or coinsurance, and routine exams with a 20% coinsurance and no copay. Prescription hearing aids are covered up to $1,500 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual (HMO D-SNP) with no deductibles, offering yearly routine and diabetic eye exams with no copay, although routine exams require a 20% coinsurance. Eyewear is also covered up to a $250 annual limit with no copays, except for contact lenses which incur a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual (HMO D-SNP), offering no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $2,000 annual limit. Covered benefits include cleanings, exams, and select restorative services, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
The Aetna Medicare Dual (HMO D-SNP) plan covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Dual (HMO D-SNP) covers medical equipment with no copays, although prior authorization is required. A 20% coinsurance applies to durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual (HMO D-SNP) with prior authorization, featuring no copays for any of these services. Beneficiaries will pay a 20% coinsurance for lab services, diagnostic procedures, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Dual (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Dual (HMO D-SNP) with no copay, but only some services are covered, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (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 copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, offering a monthly $225 over-the-counter reimbursement, chronic illness meal benefits, and select wellness exams. Acupuncture is not covered under this benefit.
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