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Aetna Medicare Full Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual 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 Full Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Kansas City Metro Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual 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 Full Dual 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 Full Dual 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 Full Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.70. 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 Full Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. For prescription drug coverage, beneficiaries enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through standard mail order for up to a three-month supply. This makes essential generic medications highly accessible with zero out-of-pocket copayments. For brand-name and specialty drugs, costs are structured as a percentage of the drug cost. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred) and Tier 5 (Specialty) drugs carry a 25% coinsurance. Standard pharmacy and standard mail-order options are available for these tiers, with specialty medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual Care (HMO D-SNP) plan offers comprehensive medical coverage with no copays for most primary care visits, home health services, and diagnostic tests, though a 20% coinsurance typically applies to outpatient care, specialist visits, and durable medical equipment. Inpatient hospital stays require set copays per admission with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. This plan also features robust supplemental benefits, including up to $2,000 for dental care and a $1,500 hearing aid allowance with no copays or coinsurance. Additionally, members receive a $250 annual eyewear allowance and a $250 monthly reimbursement for over-the-counter items, helping to significantly reduce out-of-pocket healthcare expenses.
Inpatient Hospital See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per admission for acute stays and a $2,080 copay per admission for psychiatric stays. Prior authorization is required, and while unlimited additional acute days are covered at no copay, non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers partial hospitalization services with prior authorization required. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are not covered by this plan.
Emergency Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers emergency services 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 up to a $250,000 maximum plan benefit with no copays and no coinsurance.
Primary Care See details
Primary Care benefits under the Aetna Medicare Full Dual Care (HMO D-SNP) plan feature no copay for most services, with a 20% coinsurance applying to primary care, specialist, psychiatric, and mental health services, while occupational, physical, and speech therapies have no copay and no coinsurance. Some chiropractic services are covered but routine and other chiropractic services are not covered, and routine podiatry is covered for up to 12 visits a year with no copay and a 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney education and specific screenings require no copay but have a 20% coinsurance. Sub-services such as in-home safety assessments, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no deductible, offering routine exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,500 annual limit for up to two devices, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services covered by Aetna Medicare Full Dual Care (HMO D-SNP) include annual routine eye exams and follow-up diabetic exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is also covered with no copay up to a $250 annual limit, except for contact lenses which require a 20% coinsurance and no copay.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual Care (HMO D-SNP), offering up to $2,000 annually with no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require no copay and a 20% coinsurance, 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 Full Dual Care (HMO D-SNP) with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual Care (HMO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Full Dual Care (HMO D-SNP) with no copays, though prior authorization is required. Members pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Full Dual Care (HMO D-SNP) with no copay, although some services are not covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance and Medicare-defined copays, though prior authorization is required. The plan allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual Care (HMO D-SNP) covers other services with no copay and no coinsurance, including up to 12 acupuncture treatments per year, chronic illness meal benefits, and a $250 monthly reimbursement for over-the-counter items. Annual wellness exams, screening mammographies, and additional gFOBT and FIT tests are also covered, while highly integrated SNP services are not covered.
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