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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 Central 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 $14.40. 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. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order for one-, two-, or three-month supplies. For Tier 3 preferred brand drugs, the plan charges a 22% coinsurance for standard pharmacy and standard mail order fills. Tier 4 non-preferred drugs require a 25% coinsurance for all supply durations, while Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Medicare Dual (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for primary care, preventive services, diagnostic tests, and home health care. However, beneficiaries will typically pay a 20% coinsurance for outpatient hospital services, specialist visits, dialysis, and durable medical equipment. Inpatient hospital stays require a copayment of $2,160 per stay for acute care and $2,080 for psychiatric care, both with no coinsurance. For additional wellness benefits, the plan provides routine dental care up to a $2,000 annual limit and routine hearing and vision exams with no copays. Members also receive up to $1,500 per ear annually for prescription hearing aids and a $250 annual eyewear allowance with no copays. Other valuable perks include a $225 monthly reimbursement for over-the-counter items and no-cost home health services.
Inpatient Hospital See details
Aetna Medicare Dual (HMO D-SNP) covers inpatient acute hospital stays with a $2,160 copayment per stay and psychiatric stays with a $2,080 copayment per stay, both with no coinsurance. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Aetna Medicare Dual (HMO D-SNP) are covered with no copayments and a 20% coinsurance for outpatient hospital, ambulatory surgical center, and outpatient substance abuse services, which may require prior authorization. Outpatient blood services are also covered with no copay, no deductible, and a 20% coinsurance, with the deductible waived for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Dual (HMO D-SNP) covers partial hospitalization services, with prior authorization required. Depending on the service, you will owe either a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with 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
Primary care benefits under the Aetna Medicare Dual (HMO D-SNP) plan feature no copays, with coinsurance ranging from no coinsurance for occupational, physical, and speech therapies to 20% coinsurance for primary care, specialist, and mental health services. While some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and most additional benefits, while kidney disease education and specific screenings have no copay but a 20% coinsurance. Sub-services that are not covered under this plan include in-home safety assessments, medical nutrition therapy, 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
Hearing services are partially covered by Aetna Medicare Dual (HMO D-SNP), offering routine hearing exams with no copay and a 20% coinsurance, and fitting evaluations and prescription hearing aids with no copay or coinsurance. Prescription hearing aids are covered up to $1,500 per ear annually, but OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Dual (HMO D-SNP) covers vision services with no deductibles, including one routine eye exam per year with no copay and a 20% coinsurance, and follow-up diabetic eye exams with no copay. Covered eyewear has an annual maximum benefit of $250 with no copay, though contact lenses require a 20% coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual (HMO D-SNP), featuring no copay and no coinsurance for most preventive and comprehensive dental care up to a $2,000 annual limit. Medicare-covered dental services require a 20% coinsurance and no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
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, Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Dual (HMO D-SNP) plan 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, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with prior authorization required and no copayments. Diagnostic radiological services carry no coinsurance, while a 20% coinsurance applies to diagnostic procedures and tests, lab services, therapeutic radiological services, and outpatient X-ray services.
Home Health Services See details
Home health services are covered under the Aetna Medicare Dual (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation 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 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. While the plan allows for SNF admission without a prior three-day inpatient hospital stay, 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, including a monthly $225 over-the-counter item reimbursement, meals for chronic illness, annual wellness exams, and additional gFOBT and FIT screenings. Acupuncture is not covered under these additional benefits.
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