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Aetna Medicare Full Dual (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (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 Full Dual (HMO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern and Southern Utah. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual (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 Full Dual (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 Full Dual (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 Full Dual (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.80. 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 Full Dual (HMO D-SNP) prescription drug coverage details an annual drug deductible of $615. For generic medications, the plan offers no copay for Tier 1 preferred generics filled at standard pharmacies or through standard mail order. Tier 2 generic drugs require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and higher-tier medications, costs are based on coinsurance percentages. Tier 3 preferred brands have a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply to both standard pharmacy and standard mail order options.
Additional Benefits
The Aetna Medicare Full Dual (HMO D-SNP) plan offers comprehensive medical coverage, including inpatient hospital stays with a $1,930 copay and outpatient services with no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, while primary care and specialist visits feature no copay and a 20% coinsurance. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay up to day 100. For everyday wellness, the plan features no deductibles on vision and hearing services, providing a $250 annual eyewear allowance and up to $1,000 per ear annually for prescription hearing aids with no copay. Dental care is also covered with no copay, offering up to a $3,000 annual maximum for select dental services. Members also benefit from a $150 monthly over-the-counter allowance and up to 36 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Aetna Medicare Full Dual (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,930 copayment per stay and no coinsurance, subject to prior authorization. Unlimited additional days are covered with no copay for acute stays, though additional days for psychiatric stays, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Full Dual (HMO D-SNP) are covered with no copayments, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Full Dual (HMO D-SNP) covers partial hospitalization services with prior authorization required. Depending on the service, you will pay either no copay with a 20% coinsurance or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Full Dual (HMO D-SNP) 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 up to a $250,000 maximum with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual (HMO D-SNP) covers primary care, specialist visits, therapy, and mental health services with no copay and 20% coinsurance, though chiropractic services are not covered. Additional telehealth benefits are covered with no copay and no coinsurance, while routine podiatry is limited to 12 visits per year with 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Full Dual (HMO D-SNP), offering annual physicals, health education, and fitness benefits with no copay and no coinsurance, while kidney disease education and other screenings require no copay and a 20% coinsurance. Several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Full Dual (HMO D-SNP) with no deductible, featuring no copay or coinsurance for fitting evaluations and up to $1,000 per ear annually for prescription hearing aids. Routine hearing exams require a 20% coinsurance with no copay, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Full Dual (HMO D-SNP) covers vision services with no deductible, including annual routine eye exams and follow-up diabetic eye exams with no copay, though routine exams carry a 20% coinsurance. Eyewear is covered with no copay up to a $250 annual limit, with a 20% coinsurance applying to contact lenses.
Dental Services See details
Aetna Medicare Full Dual (HMO D-SNP) offers dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other dental services up to a $3,000 annual maximum. This benefit is partially covered, as maxillofacial prosthetics, implant services, and orthodontics are not covered under the plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay, though prior authorization is required. Covered Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Full Dual (HMO D-SNP) plan with prior authorization and no copayments. Diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services require no coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Full Dual (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under Aetna Medicare Full Dual (HMO D-SNP) offer no copay and no coinsurance; while some services are covered, several key programs are not covered and require a 20% coinsurance. These uncovered services include cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (HMO D-SNP) covers skilled nursing facility services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with additional days beyond the standard Medicare limit not covered.
Other Services See details
Aetna Medicare Full Dual (HMO D-SNP) partially covers other services with no copay and no coinsurance, offering benefits such as meals for chronic illness, annual wellness exams, select cancer screenings, and a $150 monthly over-the-counter allowance. Acupuncture is not covered under this plan benefit.
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