A non-government entity
Aetna Medicare Full Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (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 (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Southwest Missouri. 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 (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.80. 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 Full Dual (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 Full Dual (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 medications filled through standard pharmacies or standard mail order. This ensures that essential generic drugs are highly accessible and cost-effective. Brand-name and specialty prescriptions are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates apply to standard pharmacy and standard mail-order services.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) plan offers robust healthcare coverage with no copayments for many routine services, though certain specialized care requires cost-sharing. Inpatient hospital stays require a copay of $2,150 for acute care and $2,080 for psychiatric care, while outpatient services, primary care visits, and specialist consultations feature no copay and up to a 20% coinsurance. Emergency care is available with a $115 copay, which is waived upon admission, and urgent care has a $40 copay. Beneficiaries pay no deductible for dental, vision, and hearing benefits, which include no copay for preventive dental care up to a $2,000 annual limit and a $1,500 annual allowance per ear for prescription hearing aids. Additionally, home health care, skilled nursing facility stays, and select therapy services are fully covered with no copay and no coinsurance. The plan also features valuable extras with no copay, including a $275 monthly over-the-counter allowance, acupuncture treatments, and home-delivered meals for chronic illnesses.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Full Dual (HMO D-SNP), featuring a $2,150 copay per stay for acute care and a $2,080 copay per stay for psychiatric care, both with no coinsurance and requiring prior authorization. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and a 20% coinsurance for hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these outpatient services, though there is no deductible for the first three pints of blood.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Full Dual (HMO D-SNP) with prior authorization, costing either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Although transportation services are listed as covered, trips to plan-approved or other health-related locations are not covered in practice.
Emergency Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services carry a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum limit.
Primary Care See details
Aetna Medicare Full Dual (HMO D-SNP) covers primary care, specialist, mental health, psychiatric, and podiatry services with no copay and up to a 20% coinsurance, though chiropractic services are not covered in practice. Occupational, physical, and speech therapies, as well as telehealth services, are covered with no copay and no coinsurance.
Preventive Services See details
Preventive services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance for annual physicals, health education, and fitness benefits. Other covered services like kidney disease education and glaucoma screenings have no copay but require a 20% coinsurance, while several supplemental benefits including weight management and nutritional services are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) with no deductible, offering no copay and no coinsurance for prescription hearing aids up to $1,500 per ear annually. Routine hearing exams have no copay but require a 20% coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers vision services with no deductible, offering annual routine eye exams and follow-up diabetic exams with no copay and 20% coinsurance for routine exams. Covered eyewear, including eyeglasses and contact lenses, features no copay and a 20% coinsurance on contact lenses, up to a $250 annual maximum benefit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), which offers a $2,000 annual maximum for other dental services with no copay and no coinsurance for most preventive and restorative treatments. Medicare-covered dental services require no copay and a 20% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
The Aetna Medicare Full Dual (HMO D-SNP) plan covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Full Dual (HMO D-SNP) with no copays, though prior authorization is required. Patients will 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
Aetna Medicare Full Dual (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services are provided with no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay, although a 20% coinsurance applies to intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a prior three-day inpatient hospital stay. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Full Dual (HMO D-SNP) plan are partially covered with no copays and no coinsurance for all approved benefits. This includes up to 12 acupuncture treatments annually, a $275 monthly over-the-counter reimbursement allowance, chronic illness meal benefits, and wellness screenings, while highly integrated SNP services are not covered.
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