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Aetna Medicare Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Complete (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 Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Complete (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Dallas and Surrounding counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Complete (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 Complete (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 Complete (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 Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.10. 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 Medicare Dual Complete (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, your monthly premium for Part D will be $10.10. During the initial coverage phase, you will pay the costs for drugs in each tier until your total drug costs reach $2000. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Dual Complete (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. Many services have no copay, including primary care, hearing exams, and dental cleanings. However, some services like inpatient hospital stays have a $1780 copay per admission, and other services such as outpatient services, vision exams, and medical equipment have coinsurance requirements. This plan also provides coverage for emergency services, ambulance services, and transportation to health-related locations, with specific copays and coinsurance amounts. Preventive services like annual physical exams are available with no copay, while other preventive services may have copays or coinsurance. Additionally, the plan covers home health services, home infusion, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Medicare-covered stays, the copay is $1780 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a coinsurance of 0% - 20%, observation services with a 20% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 0% and 20%, outpatient substance abuse services with a 20% coinsurance for individual and group sessions, and outpatient blood services with a 20% coinsurance. The plan waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 24 one-way trips per year. 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 by the Aetna Medicare Dual Complete (HMO D-SNP) plan. Emergency Services have a $110 copay with no coinsurance, and Urgently Needed Services have a $45 copay with no coinsurance; Worldwide Emergency Services has a copay, depending on the service.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with no copay, Occupational Therapy Services with no coinsurance and no copay, Physician Specialist Services with no copay, Mental Health Specialty Services with no copay for individual and group sessions, Podiatry Services with no copay, Other Health Care Professional with no copay, Psychiatric Services with no copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with no copay and no coinsurance, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with no copay; however, Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include no copay for annual physical exams. Additional preventive services include a copay for certain services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices, and Wigs for Hair Loss Related to Chemotherapy. Services like Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Hearing exams have no deductible, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid have no copay and a 20% coinsurance, while Prescription Hearing Aids have no copay.
Vision Services See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance and eyewear with a 20% coinsurance and a combined maximum of $325 per year. Routine eye exams and other eye exam services have no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Dual Complete (HMO D-SNP) plan covers dental services, with a 20% coinsurance for Medicare dental services; other dental services have a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services have no copay. Restorative services, endodontics, periodontics, prosthodontics (removable & fixed), and oral and maxillofacial surgery have no copay. Orthodontics, maxillofacial prosthetics, and implant services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Complete (HMO D-SNP) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered, with varying cost-sharing depending on the service. Durable Medical Equipment (DME) has a 20% coinsurance, while Diabetic Supplies have no coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Prosthetics/Medical Supplies also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Complete (HMO D-SNP) plan. Diagnostic Procedures/Tests 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 Medicare Dual Complete (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 covered, but none of the sub-services are covered. The plan does not specify any cost-sharing details for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and the copay information can be found in the plan details.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and Other 1 and Other 2 with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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