A non-government entity
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 AR HVP 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 $4.20. 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:
Sign up for Aetna Medicare Dual Extra Care (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Dual Extra Care (HMO D-SNP) offers an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. During the initial coverage phase at standard pharmacies, you will pay no copay for Tier 1 preferred generic drugs. For other tiers, you will pay a 22% coinsurance for Tier 2 standard generics and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. If you qualify for the low-income subsidy (LIS), your Part D cost is reduced to $4.20. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Dual Extra Care (HMO D-SNP) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, and home health services. For specialized medical needs, specialist visits and diagnostic tests require low copays and no coinsurance, while emergency care incurs a $115 copay. Inpatient hospital stays require a daily copay of $320 for the first six days, followed by no copay for additional days up to day 90. This plan also includes valuable supplemental benefits, such as routine dental and vision care with no copayments or coinsurance up to generous annual limits, including a $1,200 dental allowance and $250 for eyewear. Routine hearing exams and hearing aids are covered with no copay, and members receive a $55 monthly over-the-counter allowance with no copay. Medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping to keep out-of-pocket costs predictable.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require prior authorization and a $320 daily copay for days 1 through 6 (no copay for days 7 through 90), while psychiatric stays require prior authorization and a $678 daily copay for days 1 through 3 (no copay for days 4 through 90).
Outpatient Services See details
Outpatient services are covered under Aetna Medicare Dual Extra Care (HMO D-SNP), featuring no copay or coinsurance for ambulatory surgical center and blood services. Outpatient hospital visits require a copay of $0 to $380 with no coinsurance, while observation services incur a $380 copay per stay with no coinsurance. Outpatient substance abuse services require a $40 copay and no coinsurance for individual sessions, or a 20% coinsurance with no copay for group sessions.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with a copay ranging from $105.00 to $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) covers ground ambulance services with a $290 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay or coinsurance, though 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, and urgent care with a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance, up to a $250,000 maximum benefit limit.
Primary Care See details
Primary care benefits under Aetna Medicare Dual Extra Care (HMO D-SNP) are covered with no copay and no coinsurance for primary care provider visits and telehealth services. Additional services like specialist visits, physical therapy, and mental health sessions are covered with copays ranging from $10 to $40 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and no coinsurance for annual physical exams and most screenings, while kidney disease education requires a 20% coinsurance and no copay. Uncovered sub-services 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, 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, offering routine hearing exams and fitting evaluations annually with no copay, no deductible, and no coinsurance, while Medicare-covered exams require a $15 copay. Prescription hearing aids (all types) are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no deductibles or coinsurance, featuring a $0 to $15 copay for eye exams, which includes one routine exam per year at no copay. Additionally, eyewear is covered with no copay up to a combined maximum plan benefit of $250 every year for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Dual Extra Care (HMO D-SNP) plan, with maxillofacial prosthetics, implant services, and orthodontics being excluded from coverage. Medicare-covered dental services require a $15 copay and no coinsurance, while other covered preventive and comprehensive dental services feature no copay and no coinsurance up to a $1,200 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with prior authorization and step therapy required. Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Extra Care (HMO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Dual Extra Care (HMO D-SNP), with prior authorization required. Lab and outpatient X-ray services have no copay or coinsurance, while diagnostic tests have a $0 to $95 copay and no coinsurance. Diagnostic radiological services require up to 20% coinsurance, and therapeutic radiological services require 20% coinsurance with no copay.
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 the Aetna Medicare Dual Extra Care (HMO D-SNP) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services, as additional days beyond the Medicare-covered limit are not covered. There is no coinsurance for this benefit, which features no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with prior authorization required.
Other Services See details
Aetna Medicare Dual Extra Care (HMO D-SNP) partially covers other services with no copay and no coinsurance for covered benefits, including a chronic illness meal benefit, wellness exams, and a $55 monthly over-the-counter allowance. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved