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 Central 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 $20.40. 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:
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 prescription drug deductible of $615. For generic medications, this plan offers excellent savings with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through standard mail order. For brand-name and specialty medications, costs are calculated using coinsurance. Tier 3 (Preferred Brand) drugs require a 22% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance for standard pharmacy and standard mail-order fills.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) offers comprehensive medical coverage with many essential services requiring no copay, though coinsurance or fixed copays may apply depending on the service. For instance, inpatient hospital stays require a copay of $2,210 for acute care and $2,080 for psychiatric care with no coinsurance, while emergency room visits carry a $115 copay. Most outpatient, diagnostic, and dialysis services feature no copay and a 20% coinsurance. Beneficiaries enjoy no copay and no coinsurance for home health, skilled nursing, and therapies like physical and occupational therapy. Specialty benefits include dental care up to a $2,000 annual limit, routine vision exams, and up to two prescription hearing aids per year with no copay. Additionally, the plan provides a $275 monthly over-the-counter item reimbursement with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) with no coinsurance, requiring a copayment of $2,210 per stay for acute care and $2,080 per stay for psychiatric care. Prior authorization is required, and 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, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial hospitalization services are covered by Aetna Medicare Full Dual (HMO D-SNP), subject to prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers emergency services with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays or coinsurance up to a maximum benefit limit of $250,000.
Primary Care See details
Aetna Medicare Full Dual (HMO D-SNP) primary care benefits feature no copays for most services, with a 20% coinsurance applying to primary care, specialist, psychiatric, and mental health services. Occupational, physical, and speech therapy, along with telehealth services, are covered with no copay and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Full Dual (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney disease education and other screenings carry no copay and 20% coinsurance. Not covered under this plan are in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based 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, offering fitting evaluations and up to two prescription hearing aids per year (up to $1,500 per ear) with no copay and no coinsurance, alongside annual routine exams with no copay and 20% coinsurance. However, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) vision services cover annual routine eye exams and eyewear with no deductibles and no copays. Routine exams and contact lenses require a 20% coinsurance, while other exams, eyeglasses, and frames have no coinsurance, with eyewear coverage limited to a $250 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), offering up to a $2,000 annual maximum for non-Medicare dental care. Medicare-covered dental services require prior authorization and have no copay and a 20% coinsurance, while other covered dental services have no copay and no coinsurance, excluding maxillofacial prosthetics, implant services, and orthodontics.
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 carry a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual (HMO D-SNP) covers medical equipment with no copays, subject to prior authorization requirements. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance, 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 no copays, though prior authorization is required. Covered diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by Aetna Medicare Full Dual (HMO D-SNP) with no copay, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry a 20% coinsurance.
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, although prior authorization is required. The plan allows SNF admission without requiring a prior three-day inpatient hospital stay, but does not cover additional days beyond the standard Medicare-covered limit.
Other Services See details
Aetna Medicare Full Dual (HMO D-SNP) provides partially covered other services with no copay and no coinsurance, which include a $275 monthly over-the-counter item reimbursement, meals for chronic illnesses, and select wellness exams. Acupuncture is not covered under this benefit.
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