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Aetna Medicare Partial Dual (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Partial 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 Partial Dual (HMO-POS D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Partial 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 Partial 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 Partial 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 Partial 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 Partial 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 Partial Dual (HMO-POS D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are fully covered with no copay for standard pharmacy and mail-order prescriptions. For Tier 2 generic drugs, you will pay a standard copay of $10 for a 1-month supply, $20 for a 2-month supply, and $30 for a 3-month supply. For higher-tier medications, costs transition to coinsurance, with Tier 3 preferred brand drugs requiring a 22% coinsurance across all supply lengths. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a 1-month supply. These standard pharmacy and mail-order rates help you easily estimate your out-of-pocket prescription costs.
Additional Benefits
The Aetna Medicare Partial Dual (HMO-POS D-SNP) plan offers comprehensive medical coverage, generally featuring no copay and a standard 20% coinsurance for outpatient services, doctor visits, and diagnostic tests. For inpatient hospital stays, members pay a flat copay of $2,230 for acute care and $2,080 for psychiatric care with no coinsurance. Emergency room visits require a $115 copay, which is waived if you are admitted within 24 hours, while urgently needed care carries a $40 copay. Several key benefits are fully covered with no copay and no coinsurance, including home health services, skilled nursing facility care, telehealth, and annual physical exams. The plan also features routine vision and hearing benefits with no deductibles, offering up to $1,000 per ear annually for prescription hearing aids and a $125 annual eyewear allowance. Routine dental services are covered with no copay up to a $1,000 annual maximum, alongside a $25 monthly over-the-counter allowance for added savings.
Inpatient Hospital See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Partial Dual (HMO-POS 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 of these outpatient services, and there is no deductible for blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with prior authorization required. Depending on the treatment, costs will either be a $110.00 copay with no coinsurance, or no copay with a 20% coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Partial Dual (HMO-POS D-SNP), featuring a 20% coinsurance and no copay for prior-authorized ground and air ambulance services. While some transportation services are covered, trips to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers emergency services with a $115 copay, which is waived if admitted 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 copay or coinsurance, up to a $250,000 maximum plan benefit.
Primary Care See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and opioid treatment services with no copay and 20% coinsurance, while telehealth services feature no copay and no coinsurance. Other healthcare professional services have no copay and up to 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan, offering no copay and no coinsurance for annual physical exams, though a 20% coinsurance and no copay apply to kidney disease education and select screenings. Multiple services are not covered under this plan, including medical nutrition therapy, weight management programs, alternative therapies, therapeutic massage, adult day health, and nutritional, dietary, or in-home support services.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Partial Dual (HMO-POS D-SNP) with no deductible, featuring no copay and a 20% coinsurance for routine exams, and no copay or coinsurance for fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to $1,000 per ear annually, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers vision services with no deductible, offering annual routine eye exams and follow-up diabetic exams with no copay and a 20% coinsurance for routine exams. Eyewear is covered up to $125 annually with no copay, featuring a 20% coinsurance for contact lenses and no coinsurance for eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, alongside other covered dental services with no copay, no coinsurance, and a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Partial Dual (HMO-POS D-SNP) with no copay, though prior authorization is required. Under this benefit, Part B insulin carries a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are also covered with no copay and no coinsurance, while diabetic therapeutic shoes or inserts require a 20% coinsurance, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. Diagnostic radiological services feature no coinsurance, while diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Partial Dual (HMO-POS D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) covers cardiac rehabilitation services with no copay and a 20% coinsurance. This comprehensive coverage includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Partial Dual (HMO-POS D-SNP) with no copay and no coinsurance, although prior authorization is required. A three-day prior inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Partial Dual (HMO-POS D-SNP) offers partial coverage for other services with no copay and no coinsurance for covered benefits, which include a $25 monthly over-the-counter allowance, chronic illness meals, annual wellness exams, and additional colorectal screenings. Acupuncture and highly integrated services for dual eligible SNPs are not covered.
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