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Aetna Medicare Dual Extra Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra 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 Extra Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Central and Northwest AR Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra 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 Extra 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 Extra 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 Extra Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Extra Care (HMO D-SNP) features an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. If you qualify for the Low-Income Subsidy, also known as Extra Help, your premium and costs may be reduced to $0. After meeting your deductible, you will pay standard pharmacy costs during the initial coverage phase until your total drug costs reach $2,100.00. During the initial coverage phase, you will benefit from no copay for Tier 1 preferred generic drugs. Tier 2 standard generics require a 22% coinsurance, while Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance. Once your yearly out-of-pocket costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) plan offers comprehensive coverage with varying out-of-pocket costs depending on the service. For inpatient hospital stays, members pay a copay of $1,650 for acute care or $1,720 for psychiatric stays, while outpatient services, primary care, and specialist visits generally feature no copay but require a 10% to 20% coinsurance. Emergency care is accessible with a $115 copay, which is waived if admitted, and urgent care has a $40 copay. This plan also includes valuable supplemental benefits like routine dental care up to $1,750 annually and routine vision care with a $350 annual eyewear allowance, both featuring no copays. Additionally, members can access routine hearing exams, a $500 annual hearing aid allowance per ear, up to 24 one-way transportation trips, and a $130 monthly over-the-counter allowance with no copay. Home health services and select preventive care are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no coinsurance, requiring prior authorization. Acute care stays require a $1,650 copay per stay with unlimited additional days at no copay, while psychiatric stays require a $1,720 copay per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan with no copay and a 20% coinsurance for outpatient hospital visits, observation services, ambulatory surgical center services, outpatient substance abuse treatment, and outpatient blood services. Prior authorization is required for most of these covered services.
Partial Hospitalization See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers partial hospitalization benefits, which require prior authorization. Members are responsible for either a $110 copay or a 20% coinsurance for covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if 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 available with no copay up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers primary care physician services with a 10% coinsurance and specialist, therapy, and psychiatric services with a 20% coinsurance. Members pay no copay for additional telehealth, Medicare-covered podiatry, and up to 12 routine chiropractic visits per year, though prior authorization is required for some services.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), offering annual physicals, fitness benefits, and personal emergency response systems with no copay and no coinsurance, while kidney disease education and glaucoma screenings require a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially 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 and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, but OTC hearing aids and specific prescription types—including inner ear, outer ear, and over-the-ear—are not covered.
Vision Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers vision services, including one routine eye exam per year and contact lenses with no copay and 20% coinsurance. Other covered services, including follow-up diabetic eye exams, eyeglasses, frames, lenses, and upgrades, have no copay and no coinsurance, up to a combined maximum eyewear benefit of $350 annually with no deductibles.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) up to a $1,750 annual maximum, offering no copay and no coinsurance for most covered preventive and comprehensive dental care. 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 Extra Care (HMO D-SNP) with prior authorization, featuring a $35 copay and no coinsurance for Medicare Part B insulin. Chemotherapy, radiation, and other Part B drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copays, though prior authorization is required. Durable medical equipment and medical supplies carry a 0% to 20% coinsurance, prosthetic devices and diabetic shoes have a 20% coinsurance, and diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay, and coinsurance ranging from no coinsurance up to 20% depending on the specific service. Prior authorization is required for these services, which include lab work, outpatient X-rays, and therapeutic radiological procedures.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Dual Extra Care (HMO D-SNP) because none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered. Consequently, there are no plan copay or coinsurance benefits available for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP), though additional days beyond the Medicare-covered limit are not covered. For covered stays, there is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance, with prior authorization required.
Other Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers other services—such as acupuncture, chronic illness meals, additional wellness screenings, and a monthly $130 over-the-counter allowance—with no copay or coinsurance. These benefits are partially covered, as Dual Eligible SNPs with Highly Integrated Services are excluded.
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