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Aetna Medicare Dual Care (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Dual Care (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Care (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 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 Dual Care (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 Dual Care (HMO D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one-month, two-month, and three-month supplies filled through standard pharmacies or standard mail order. This helps keep everyday prescription costs low for those who rely on generic drugs. For higher-tier medications, the plan transitions to a coinsurance model for standard pharmacy and mail-order fills. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers comprehensive medical coverage with no copay for primary care, home health, and outpatient services, though a 20% coinsurance typically applies to outpatient care, dialysis, and durable medical equipment. Inpatient hospital stays require a $1,920 copay per stay with no coinsurance, while emergency room visits feature a $115 copay. Skilled nursing facility care is also covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. For routine wellness and specialty care, the plan provides excellent value with no copay for annual physicals, routine eye exams, and dental care up to a $3,000 annual limit. Members also enjoy valuable extra perks, including prescription hearing aids covered up to $2,000 annually, a $300 annual eyewear allowance, and a monthly over-the-counter allowance of up to $160. Many of these services, including outpatient care and diagnostic imaging, may require prior authorization.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital services with a $1,920 copay per stay, no coinsurance, and prior authorization required. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered for acute care, and additional days and non-Medicare-covered stays are excluded for psychiatric care.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers outpatient services, including outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and the deductible is waived for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Dual Care (HMO D-SNP) covers partial hospitalization services with no copay and a coinsurance of either 20% or 30%. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. However, transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Dual Care (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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the Aetna Medicare Dual Care (HMO D-SNP) are covered with no copay and generally require a 20% coinsurance, though podiatry and other healthcare professional services range from 0% to 20% coinsurance. Additional telehealth benefits are available with no copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physicals, but requiring a 20% coinsurance and no copay for kidney education and screenings. Non-covered sub-services include in-home safety assessments, medical nutrition therapy, post-discharge 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 Dual Care (HMO D-SNP) offers partially covered hearing services, featuring routine hearing exams with a 20% coinsurance and no copay, alongside fitting evaluations with no copay. Prescription hearing aids are covered up to $2,000 annually with no copay or coinsurance, 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 are covered by Aetna Medicare Dual Care (HMO D-SNP) with no deductible, offering routine and diabetic eye exams with no copay and a 20% coinsurance for routine exams. Eyewear is also covered with no copay, except for contact lenses which require a 20% coinsurance, up to a combined maximum plan benefit of $300 per year.
Dental Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance, and other dental services with no copay, no coinsurance, and a $3,000 annual maximum. While a wide range of preventive and comprehensive dental services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are subject to a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Care (HMO D-SNP) covers medical equipment, prosthetics, and diabetic supplies with no copays, though prior authorization is required for these services. While diabetic supplies are covered with no coinsurance, a 20% coinsurance applies to durable medical equipment, medical supplies, prosthetic devices, and diabetic therapeutic shoes or inserts.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (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 covered with no coinsurance.
Home Health Services See details
Aetna Medicare 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 by Aetna Medicare Dual Care (HMO D-SNP) with no copay, but some services are not covered in practice, including standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD, which require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and although a three-day prior inpatient hospital stay is not required, additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered under Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for a chronic illness meal benefit, wellness exams, and a monthly over-the-counter (OTC) allowance of up to $160. Acupuncture is not covered under this plan.
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