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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 Eastern/Central Missouri. 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 $43.40. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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, you will pay $43.40 per month for Part D. After the deductible, you will pay the cost-sharing amounts for each drug tier until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you will enter the catastrophic coverage phase, and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan provides coverage for a wide array of medical services, including inpatient and outpatient care, with varying cost-sharing structures. Many services have a 20% coinsurance, while others, such as emergency services, have a copay. The plan covers ambulance services with 20% coinsurance and transportation to plan-approved health locations with no copay. This plan also offers additional benefits, such as vision, hearing, and dental services, with different cost-sharing options. Preventive services, like an annual physical exam, are covered with no copay. The plan also covers home health services with no copay and provides an over-the-counter (OTC) allowance of up to $225 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. The copay for a Medicare-covered stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric is $1980 per admission or per stay, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance, and observation services, with a 20% coinsurance. The 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 the Aetna Medicare Assure (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are 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 20% coinsurance, chiropractic services with 20% coinsurance, occupational therapy services with no copay and no coinsurance, physician specialist services with 20% coinsurance, and mental health specialty services with 20% coinsurance. The plan also covers podiatry services and other health care professional services with 20% coinsurance, psychiatric services with 20% coinsurance, physical therapy and speech-language pathology services with no copay and no coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with 20% coinsurance. Routine Chiropractic Care is not covered.
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 are covered, with copays for specific services such as Health Education, Nutritional/Dietary Benefit, and In-Home Support Services. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of up to 20% and a copay for Medicare-covered benefits and hearing aid fittings/evaluations, while prescription hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $2500 per year.
Vision Services See details
Vision services include eye exams with 20% coinsurance, and eyewear. Routine eye exams have no copay and are limited to one per year, while other eye exam services have no copay and are unlimited. Eyewear has a combined maximum plan benefit coverage amount of $515 per year, with contact lenses covered with no copay, and eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all covered with no copay.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services are covered with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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, including durable medical equipment with a 20% coinsurance and no copay, prosthetics and medical supplies with a 20% coinsurance and no copay, and diabetic equipment. Diabetic supplies have no coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered with no copay. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have no coinsurance.
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; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered days, or non-Medicare-covered stays. There is a copay for SNF services; see the plan details for more information on the cost share.
Other Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $225 per month. The plan also covers meal benefits and other services such as annual wellness exams and screening mammograms, and gFOBT/FIT with no copay. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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