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Aetna Medicare Full Dual (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (HMO-POS 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-POS D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Connecticut. 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-POS 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-POS 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-POS 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-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.80. 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:
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Drug Coverage
The Aetna Medicare Full Dual (HMO-POS D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are highly affordable with no copay for up to a three-month supply at standard pharmacies and standard mail-order services. For Tier 2 generic medications, you will pay a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher-tier prescription drugs are subject to coinsurance rather than set copays at standard pharmacies and mail-order facilities. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Understanding these tier-based costs can help you manage your out-of-pocket prescription expenses with this Medicare plan.
Additional Benefits
The Aetna Medicare Full Dual (HMO-POS D-SNP) plan offers comprehensive medical coverage featuring no copay and up to 20% coinsurance for primary care, specialist visits, and outpatient hospital services. Inpatient hospital stays require a copay of $2,100 per stay for acute care and $2,080 for psychiatric care, while emergency room visits have a $115 copay which is waived if you are admitted. Additionally, telehealth, home health, and skilled nursing facility services are fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits, offering preventive care, annual physicals, and wellness exams with no copay and no coinsurance. Routine dental, vision, and hearing services feature no copays, offering up to a $1,500 annual limit for dental care, a $175 annual allowance for eyewear, and up to $1,250 per ear yearly for hearing aids. Members also receive up to $150 monthly for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,100 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Prior authorization is required for these services, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Full Dual (HMO-POS D-SNP) with no copay and a 20% coinsurance for 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
The Aetna Medicare Full Dual (HMO-POS D-SNP) covers partial hospitalization services, which require prior authorization. Depending on the service, your costs will be 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-POS D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and 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-POS D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and up to 20% coinsurance, whereas telehealth features no copay and no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic care are not.
Preventive Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers annual physical exams and zero-dollar preventive services with no copay and no coinsurance, while other preventive services like kidney education and glaucoma screenings have no copay and a 20% coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but do not cover in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, or counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Full Dual (HMO-POS D-SNP) with no deductible, including one annual routine exam with no copay and 20% coinsurance, and one fitting evaluation with no copay or coinsurance. Prescription hearing aids are partially covered up to $1,250 per ear yearly with no copay or coinsurance, though inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan feature no deductible, offering one annual routine eye exam with no copay and a 20% coinsurance, alongside follow-up diabetic eye exams with no copay. Covered eyewear, including eyeglasses and contact lenses, has no copay up to a $175 annual maximum, though contact lenses require a 20% coinsurance and Medicare-covered vision benefits are subject to copays.
Dental Services See details
Dental services are partially covered by Aetna Medicare Full Dual (HMO-POS D-SNP), featuring Medicare-covered dental care with no copay and 20% coinsurance, and other dental benefits with no copay, no coinsurance, and a $1,500 annual limit. While many preventive and comprehensive services are covered, 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 (HMO-POS D-SNP) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
The Aetna Medicare Full Dual (HMO-POS 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-POS D-SNP) with no copays, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment (DME), 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 (HMO-POS D-SNP) with prior authorization required and no copays. There is no coinsurance for diagnostic radiological services, while outpatient diagnostic procedures, lab services, therapeutic radiological services, and X-rays have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Full Dual (HMO-POS D-SNP) plan, as sub-services including intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice. While there is no copay, these services require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (HMO-POS D-SNP) covers Skilled Nursing Facility (SNF) services with no copayment and no coinsurance, though prior authorization is required. The plan allows admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Full Dual (HMO-POS D-SNP) provides partially covered Other Services with no copay and no coinsurance for covered benefits, which include chronic illness meals, annual wellness exams, and up to $150 monthly in over-the-counter item reimbursements. Acupuncture is not covered under this plan.
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