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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 Western KS: Saline and surrounding counties. 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 $47.80. 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. After the deductible, you will pay the costs for your prescriptions based on the drug tier, but the specific costs for each tier are not available in this summary. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, the plan's premium may be reduced.
Additional Benefits
The Aetna Medicare Assure (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have a $2,000 copay per admission, while outpatient services, primary care, and other services often have a 20% coinsurance. Emergency services have a copay, and ambulance services have a 20% coinsurance. Preventive, hearing, and dental services have no copay, while vision services have a 20% coinsurance. The plan also includes coverage for home health with no copay, and other services like acupuncture and over-the-counter items with no copay, but the plan may have annual limits on coverage.
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 is $2,000 per admission or stay.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered with a 20% coinsurance. Ambulatory Surgical Center (ASC) services and outpatient substance abuse services are covered with a coinsurance of 20%. Outpatient blood services are covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Assure (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location has no copay, and includes up to 6 one-way trips per year via rideshare, bus/subway, or medical transport; transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy, Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Physician Specialist Services, Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, Individual and Group Sessions for Mental Health and Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance, while Chiropractic Services and Additional Telehealth Benefits have no copay. 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. Other preventive services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications have a copay; Wigs for Hair Loss Related to Chemotherapy have no copay. Other Preventive Services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have 20% coinsurance.
Hearing Services See details
Hearing exams are covered, including routine hearing exams, with a coinsurance of at most 20% for routine hearing exams, and no copay. Prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers vision services including eye exams, with a 20% coinsurance for routine eye exams, and eyewear with a 20% coinsurance for contact lenses. Routine eye exams and other eye exam services have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage of $325 every year.
Dental Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, and other preventive services with no copay. Medicare dental services have a 20% coinsurance, and other dental services have a maximum benefit of $1,500 per year. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery are covered with no copay, but are limited by the plan. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with 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. The plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Assure (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance, while Diabetic Supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Assure (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have no coinsurance, and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
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 covered by Aetna Medicare Assure (HMO D-SNP), but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is coinsurance for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and the cost sharing is based on the Medicare-defined cost share for tier 1.
Other Services See details
The Aetna Medicare Assure (HMO D-SNP) plan covers acupuncture with no copay, up to 12 treatments per year. Over-the-counter items are covered with no copay and a maximum benefit of $235 per month, including nicotine replacement therapy and naloxone. The plan also covers a meal benefit with no copay, and other services with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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