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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 Dallas and Surrounding Counties. 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 $0.00. 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) plan features an annual drug deductible of $615. Fortunately, beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supplies of these generic drugs. For brand-name and specialty medications, your costs are determined by coinsurance rather than flat copayments. You will pay a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (HMO D-SNP) plan provides comprehensive coverage with no copay and no coinsurance for primary care, specialist visits, home health, and skilled nursing facility services. Inpatient hospital stays require a $1,890 copay per stay with no coinsurance, while outpatient and diagnostic services generally feature no copay and a coinsurance ranging from 0% to 20%. Emergency room visits have a $115 copay, which is waived upon admission, and urgent care services require a $40 copay. Supplemental benefits like dental, vision, and hearing are covered with no deductibles, offering a mix of no copays and up to 20% coinsurance alongside annual allowances for eyewear and hearing aids. Members also benefit from no-copay transportation for up to 24 one-way trips per year and a $70 monthly allowance for over-the-counter products. Essential medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers inpatient hospital services, requiring a $1,890.00 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (HMO D-SNP) outpatient services are covered with no copay, though coinsurance ranges from 0% to 20% depending on the specific service. Prior authorization is required for outpatient hospital, ambulatory surgical center, and substance abuse services, while blood services carry a 20% coinsurance with no deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under Aetna Medicare Dual Care (HMO D-SNP) and requires prior authorization. Depending on the service, you will owe either a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Care (HMO D-SNP), featuring a 20% coinsurance and no copay for prior-authorized ground and air ambulance rides. Transportation benefits are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, though transportation to any health-related location is 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 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 or coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Dual Care (HMO D-SNP) covers primary care, specialist visits, physical, occupational, and speech therapies, podiatry, mental health, and telehealth services with no copay and no coinsurance. Prior authorization is required for mental health, psychiatric, and telehealth services, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Care (HMO D-SNP), featuring no copay and no coinsurance for annual physical exams, zero-dollar preventive care, and select supplemental benefits like fitness programs. While kidney disease education and specific screenings require a 20% coinsurance and no copay, several services are not covered, including medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and in-home support.
Hearing Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers hearing services with no deductible, offering routine hearing exams for a 20% coinsurance and no copay, alongside fitting evaluations and prescription hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers vision services with no deductibles, offering routine eye exams and contact lenses with a 20% coinsurance and no copay. Eyeglasses, upgrades, and follow-up diabetic eye exams have no copay and no coinsurance, with eyewear benefits capped at a combined maximum of $350 every year.
Dental Services See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers dental services, providing Medicare-covered dental care with no copay and 20% coinsurance, and other dental services up to a $1,000 annual maximum with no copay and no coinsurance. While many preventive and comprehensive services like cleanings and restorative care are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no 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
Medical Equipment benefits under Aetna Medicare Dual Care (HMO D-SNP) are covered with no copay, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic shoes require 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, though prior authorization is required. Diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays are subject to a 20% coinsurance, while diagnostic radiological services are covered with 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 by Aetna Medicare Dual Care (HMO D-SNP) with no copay, but specific services like standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copayment and no coinsurance, requiring prior authorization. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the Aetna Medicare Dual Care (HMO D-SNP) plan are partially covered, offering no copay and no coinsurance for chronic illness meal benefits, select wellness and screening exams, and up to $70 monthly for over-the-counter items. Acupuncture and highly integrated SNP services are not covered under this benefit.
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