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Aetna Assure Premier Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Assure Premier Plus (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 Assure Premier Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Assure Premier Plus (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in New Jersey Counties: All. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Assure Premier Plus (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 Assure Premier Plus (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 Assure Premier Plus (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 Assure Premier Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.20. 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 $590.00 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 $9350.00 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 Assure Premier Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), the plan's premium may be reduced. During the initial coverage phase, you pay the costs for drugs in each tier. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Assure Premier Plus (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a high copay per admission, while outpatient services, partial hospitalization, and some primary care and preventive services have coinsurance. Emergency and urgent care services have a copay, and ambulance services have a coinsurance. The plan covers many services with either no copay or coinsurance, including home health services, diagnostic and radiological services, and over-the-counter items. You will have coinsurance for services like vision, dental, and hearing, and some medical equipment. Some services are not covered, such as cardiac rehabilitation and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, there is a copay of $2,185 per admission or stay, and for Inpatient Hospital Psychiatric, there is a copay of $2,036 per admission or stay; additional days, non-Medicare-covered stays, and upgrades for both are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, have a 20% coinsurance, while Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services also have a 20% coinsurance. Outpatient Blood Services includes an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Aetna Assure Premier Plus (HMO D-SNP) covers partial hospitalization with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no copay for any ambulance services. Ground and Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Assure Premier Plus (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay and there is no coinsurance for either service. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no coinsurance.
Primary Care See details
The Aetna Assure Premier Plus (HMO D-SNP) plan covers Primary Care Physician Services with no coinsurance, Chiropractic Services with 20% coinsurance, Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 20% coinsurance, Mental Health Specialty Services and Psychiatric Services with a 20% coinsurance, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with no coinsurance, and Opioid Treatment Program Services with 20% coinsurance; however, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Aetna Assure Premier Plus (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Other preventive services have coinsurance of 20% for services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services are partially covered by the Aetna Assure Premier Plus (HMO D-SNP) plan. Routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered, while other hearing exams have at most 20% coinsurance, and no deductible.
Vision Services See details
Vision services are covered, with a 20% coinsurance for eye exams and eyewear, but routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered. There is no deductible for these services.
Dental Services See details
Dental services are covered, with a 20% coinsurance. Orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Assure Premier Plus (HMO D-SNP) plan and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Assure Premier Plus (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and no copay, prosthetics/medical supplies with 20% coinsurance and no copay, and diabetic equipment. Diabetic supplies have no coinsurance, while diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. There is no copay for any of these services. Diagnostic procedures and lab services have a coinsurance of at most 20%, while diagnostic radiological services have a coinsurance of 0%, and therapeutic radiological services and outpatient X-ray services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Assure Premier Plus (HMO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Assure Premier Plus (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan charges the Medicare-defined cost share for tier 1, and additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Assure Premier Plus (HMO D-SNP) plan covers Over-the-Counter (OTC) items with no copay, a maximum benefit coverage amount of $240 every month, and includes Nicotine Replacement Therapy (NRT) and Naloxone coverage. The plan also covers meal benefits and other services, including annual wellness exams, screening mammography, gFOBT, and FIT, all with no copay. Acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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