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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 Nebraska. This plan received an overall rating of 3.5 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 $41.50. 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) prescription drug plan features an annual deductible of $615. Beneficiaries can save significantly on generic medications, as there is no copay for Tier 1 Preferred Generic and Tier 2 Generic drugs filled through standard pharmacies or standard mail order. For brand-name and higher-tier medications, cost-sharing is structured as coinsurance rather than copays. You will pay a 22% coinsurance for Tier 3 Preferred Brand drugs, and a 25% coinsurance for Tier 4 Non-Preferred and Tier 5 Specialty drugs filled at standard pharmacies or standard mail order.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan offers robust healthcare coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies to these visits. Inpatient hospital stays require a $1,940 copayment per admission, while emergency room visits carry a $115 copay that is waived upon admission. Additionally, home health services feature no copay and no coinsurance, and skilled nursing care is available with no copay for the first 20 days. For extra wellness benefits, the plan provides dental, vision, and hearing coverage with no deductibles and no copays, though some routine exams require a 20% coinsurance. Members can access up to $2,550 annually for select dental services, a $2,000 annual allowance per ear for prescription hearing aids, and a $275 annual limit for eyewear. The plan also includes a $138 monthly over-the-counter allowance with no copay or coinsurance to help cover everyday health needs.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,940 copayment per admission and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute days are included with no copay.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copays, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and blood services. Prior authorization is required for most of these outpatient services, and there is no deductible for blood services, with the cost of the first three pints waived.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and either a 20% or 30% coinsurance. Prior authorization is required for these 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, though prior authorization is required. Routine transportation services are not covered.
Emergency Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay 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 with no copay and no coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Primary Care benefits under Aetna Medicare Dual Care (HMO D-SNP) feature no copays, though most services—including primary care, specialist visits, therapy, and mental health care—require a 20% coinsurance. Additional telehealth benefits and up to 12 routine podiatry visits per year are covered with no copay and no coinsurance. Chiropractic services are not covered in practice because routine and other chiropractic sub-services are excluded.
Preventive Services See details
Preventive services are partially covered under Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physicals and select supplemental benefits, while kidney disease education and other screenings require no copay and a 20% coinsurance. The plan does 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, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no deductible, featuring routine exams for a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $2,000 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services under the Aetna Medicare Dual Care (HMO D-SNP) plan are covered with no deductible, featuring no copay and a 20% coinsurance for routine eye exams (limited to one per year) and follow-up diabetic eye exams. Eyewear is also covered with no deductible up to a $275 annual combined maximum, offering contact lenses with no copay and a 20% coinsurance, as well as eyeglasses, lenses, frames, and upgrades with no copay.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other dental services up to a $2,550 annual limit. While most diagnostic, preventive, and restorative treatments are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers dialysis services 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 with no copays, though prior authorization is required for these services. Durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers diagnostic and radiological services with no copays, subject to prior authorization. Patients will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Dual Care (HMO D-SNP) plan with no copay, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and 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, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Dual Care (HMO D-SNP) with no copay and no coinsurance, offering a $138 monthly over-the-counter allowance, chronic illness meals, and select wellness exams. However, acupuncture is not covered under this benefit.
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