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Aetna Medicare Dual Preferred (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Preferred (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 Preferred (HMO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (HMO D-SNP) is a HMO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Salt Lake Metro and Southern Utah. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Preferred (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 Preferred (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 Preferred (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 Preferred (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $39.80. 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 $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 Preferred (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), your monthly premium for Part D is $39.80. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for your Medicare Part D covered drugs, but you may still pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Dual Preferred (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays require a $1770 copay per admission. Many services have a 20% coinsurance, including outpatient services, primary care, and dental. The plan includes no copay for many services, such as preventive services (including an annual physical), hearing exams, vision services (including eye exams and eyewear), home health services, and medical equipment. Emergency services have a copay of $110, while urgent care services have a copay of $45. The plan also covers transportation and has an OTC benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, the copay is $1770.00 per admission or stay. Additional days for Inpatient Hospital-Acute are covered, with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, and outpatient blood services have a 20% coinsurance, while individual and group sessions for outpatient substance abuse have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (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, including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered with no copay, with up to 40 one-way trips per year using rideshare services, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. For Emergency Services, you will pay a $110 copay and no coinsurance. For Urgently Needed Services, you will pay a $45 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. The plan has a 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Routine Foot Care, Individual and Group Sessions for Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan, including an annual physical exam with no copay. Additional preventive services have a copay, and some services such as in-home safety assessments, personal emergency response systems, and more are not covered.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% and a $0 copay for routine exams and fitting/evaluation for hearing aids. Prescription hearing aids have a maximum plan benefit of $1,000 per ear every year, with a $0 copay for all types of prescription hearing aids (except inner ear, outer ear, and over the ear, which are not covered).
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance for routine eye exams, and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum benefit of $250 per year.
Dental Services See details
Dental services include a 20% coinsurance for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have visit limits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with no copay for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Supplies, and 20% coinsurance for DME, Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%, and Diagnostic Radiological Services has a coinsurance of 0%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Preferred (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 by the Aetna Medicare Dual Preferred (HMO D-SNP) plan, but the plan does not cover any of the specific services. The plan has coinsurance for the services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan follows the Medicare-defined cost share for tier 1 and does not cover additional days beyond Medicare-covered SNF stays or non-Medicare-covered SNF stays.
Other Services See details
The Aetna Medicare Dual Preferred (HMO D-SNP) plan's other services include a $0 copay for Over-the-Counter (OTC) items and a $0 copay for meal benefits. 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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