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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 Metro St Louis-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 $30.40. 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 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic and Tier 2 generic drugs. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies or through standard mail order. For Tier 3 preferred brand drugs, you will pay a 22% coinsurance at standard pharmacies and standard mail order services. Tier 4 non-preferred drugs and Tier 5 specialty tier drugs both carry a 25% coinsurance rate. This 25% coinsurance applies to up to a three-month supply for Tier 4 drugs, while Tier 5 specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, outpatient services, and home health care, though a 20% coinsurance typically applies to most outpatient and specialist services. Inpatient hospital stays require a copay of up to $2,090 per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. Additionally, physical and speech therapy services, telehealth, and skilled nursing facility care are fully covered with no copay and no coinsurance. This plan also features valuable supplemental benefits, including preventive and comprehensive dental care with no copay or coinsurance up to a $2,000 annual limit, and vision coverage that includes a $250 annual allowance for eyewear. Prescription hearing aids are covered with no copay up to $1,500 per ear annually, and members receive a $275 monthly allowance for over-the-counter items. Most diagnostic tests, durable medical equipment, and dialysis require no copays but are subject to a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) inpatient hospital benefits are partially covered, requiring a $2,090 copay per stay with no coinsurance for acute care and a $2,080 copay per stay with no coinsurance for psychiatric care. Prior authorization is required for both services, while upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers outpatient services with no copays, though a 20% coinsurance applies to outpatient hospital, observation, 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 outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with prior authorization required, costing either a $110 copay with no coinsurance or no copay with 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Aetna Medicare Full Dual (HMO D-SNP) plan include Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. However, transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Full Dual (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Primary care benefits under Aetna Medicare Full Dual (HMO D-SNP) are covered with no copays, though most services like PCP and specialist visits require a 20% coinsurance. Occupational, physical, and speech therapy, alongside telehealth, are covered with no copay and no coinsurance, whereas chiropractic services are not covered in practice. Routine podiatry is covered for up to 12 visits per year with no copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Full Dual (HMO D-SNP) provides partially covered preventive services, offering no copay and no coinsurance for annual physicals and supplemental benefits, while kidney education and screenings have no copay and 20% coinsurance. Not covered 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 benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Full Dual (HMO D-SNP) partially covers hearing services with no deductible, offering routine exams for no copay and 20% coinsurance, and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are covered up to $1,500 per ear annually with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no deductibles and a $250 annual maximum limit for eyewear. Routine eye exams and contact lenses have no copay and a 20% coinsurance, while Medicare-covered exams, diabetic eye exams, and eyeglasses are covered with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), offering most preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual limit. 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
Aetna Medicare Full Dual (HMO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization and step therapy requirements. 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 carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
The Aetna Medicare Full Dual (HMO D-SNP) covers medical equipment with no copay, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes or inserts require a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services covered under the Aetna Medicare Full Dual (HMO D-SNP) plan require prior authorization and have no copays. Diagnostic tests, lab services, therapeutic radiology, and outpatient X-rays carry a 20% coinsurance, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay, but in practice, only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) with no copay and no coinsurance, though additional days beyond the Medicare-covered limit are not covered. Prior authorization is required, but the plan allows for SNF admission without a prior three-day inpatient hospital stay.
Other Services See details
Aetna Medicare Full Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, including a monthly over-the-counter item reimbursement of up to $275, a meal benefit for chronic illness, and additional wellness and screening exams. Acupuncture and highly integrated dual eligible services are not covered under this benefit.
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