Aetna Medicare Dual Care (HMO D-SNP)

HMO
Aetna
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Basic Costs and Coverage

Monthly premiums, deductibles, and core cost-sharing amounts.

CoverageCost
Monthly plan premium $0.00
Vision coverage true
Dental coverage true
Hearing coverage true
Prescription drug coverage true
Medical deductible $615.00
Out-of-pocket maximum
In$9,250.00
Combined$9,250.00
Initial drug coverage limit $0.00
Catastrophic drug coverage limit $2,100.00
Primary care doctor visit $0.00
Specialty doctor visit $0.00
Inpatient hospital care $0.00
Urgent care $0.00
Emergency room visit $0.00
Ambulance transportation $0.00

Health Care Services and Medical Supplies

Specialist services, therapies, and equipment.

ServiceCost
Chiropractic services $0.00
Diabetes supplies, training, nutrition therapy Included
Durable medical equipment (DME) Included
Diagnostic tests, lab, radiology, X-rays $0.00
Home health care B$0.00
Mental health inpatient care $0.00
Mental health outpatient care $0.00
Outpatient services / surgery $0.00
Outpatient substance abuse care $0.00
Over-the-counter items $240.00 monthly
Podiatry services $0.00
Skilled Nursing Facility (SNF) care $0.00

Dental Benefits

Preventive and comprehensive dental coverage.

CoverageCost & limits
Preventive dental Included
Comprehensive dental — covered? No
Annual dental maximum $615.00
Comprehensive dental — annual max $615.00

Vision Benefits

Routine Eye Exams and Eyewear.

CoverageCost & limits
Routine eye exam
InIncluded $0.00
Out$75 copay · 1 per year
Eyeglass frames & lenses $400.00
Eyewear allowance $400.00
Eye exam — covered? No
Eye exam supplement — max coverage Not covered

Hearing Benefits

Hearing exams, fittings, and aids.

CoverageCost & limits
Hearing exam
InIncluded
Out$0.00
Hearing exam — covered? No
Hearing aid fitting — covered? No
Hearing aid fitting cost Not covered
Hearing aids — covered? No
Hearing aids — max coverage $2000

Preventive Services

All Medicare-covered preventive services at $0 in-network.

In-Network: $0.00 copay for all Medicare-covered preventive services.
  • Abdominal aortic aneurysm screening
  • Alcohol misuse screenings & counseling
  • Bone mass measurements (bone density)
  • Cardiovascular disease screenings
  • Cardiovascular disease (behavioral therapy)
  • Cervical & vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screenings
  • Diabetes screenings
  • Diabetes self-management training
  • Glaucoma tests
  • Hepatitis B (HBV) infection screening
  • Hepatitis C screening test
  • HIV screening
  • Lung cancer screening
  • Mammograms (screening)
  • Nutrition therapy services
  • Obesity screenings & counseling
  • One-time Welcome to Medicare preventive visit
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening & counseling
  • Shots: COVID-19 · Flu · Hepatitis B · Pneumococcal
  • Tobacco use cessation
  • Yearly "Wellness" visit
Fitness / Wellness program: Not specified

Prescription Drug Costs and Coverage

Part D formulary tiers and supply length pricing.

Annual drug deductible: $615.00
Tier Drug type 30-day retail 30-day mail 90-day mail
1 Preferred generic Lowest-cost generic drugs $0.00 $0.00 $0.00
2 Generic Standard generic drugs $0.00 $0.00 $0.00
3 Preferred brand Preferred brand-name drugs 22% 22% 22%
4 Non-preferred brand Non-preferred brand drugs 25% 25% 25%
5 Specialty tier Specialty medications 25% 25% 25%

Not sure if this plan is right for you?

Peter Abilla is a licensed Medicare agent. He can walk you through this plan's costs, coverage, and whether your doctors are in-network.

Independent agent. Not affiliated with any insurance carrier.
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Smiling elderly man sees urologist paid for by medicare and young boy in a garden surrounded by blooming yellow and pink roses, the boy holding a gardening tool.Older couple have no medicare benefits because they were late to enroll, standing outdoors hugging near snow-covered evergreen trees in winter.Smiling elderly couple both under 65 and wish they had medicare sitting outdoors wrapped in warm clothing with a child standing behind them, hugging and laughing.
Overall Rating
Part C Rating
Part D Rating

Where Is This Plan Available?

See Interactive Medicare Tools

Decision area Tool What it answers
Enrollment Initial Enrollment Period Calculator When your 7-month Medicare eligibility window begins and ends based on your 65th birthday
Enrollment When Should I Sign Up for Medicare? The best time to enroll based on your work status, other coverage, and age
Enrollment Special Enrollment Period Checker Whether a life event qualifies you for enrollment outside the standard windows
Enrollment Late Enrollment Penalty Checker How much extra you'll pay monthly if you missed your enrollment window
Enrollment Part B Penalty Calculator The exact 10%-per-year premium increase for delayed Part B enrollment
Enrollment Part D Penalty Calculator The 1%-per-month premium increase for gaps in creditable drug coverage
Costs Cost Scenario Planner Estimated annual spending across plan types at different health utilization levels
Costs Advantage vs. Medigap Cost Comparison True cost difference between Medicare Advantage and Original Medicare with Medigap
Costs IRMAA Calculator Whether your income triggers higher Part B and Part D premiums
Costs Part A Premium Estimator Your monthly Part A premium based on work history and quarters of coverage
Costs M3P Calculator How the Medicare Prescription Payment Plan smooths your drug costs into monthly payments
Coverage Doctor & Drug Assessment Whether your providers and prescriptions are covered by a specific plan
Coverage Part D Shopping Tool Which Part D plan has the lowest total annual cost for your specific medications
Coverage Travel & Network Risk Assessment How your coverage works outside your home area and which plan types travel best
Employer/COBRA COBRA vs. Medicare Why COBRA can trigger permanent Medicare penalties and how costs compare
Employer/COBRA Employer Coverage vs. Medicare Whether your employer plan or Medicare is primary and when to transition
Employer/COBRA HSA & Medicare Compatibility How Medicare enrollment affects HSA eligibility and what to do before enrolling
Planning Caregiver Readiness Checklist Whether you have everything in place to help a loved one with Medicare decisions
Planning Document Gatherer Which documents you need to have ready before enrolling or changing plans
Planning Medigap Fit Assessment Whether Medigap or Medicare Advantage is the better fit for how you use healthcare
Planning Medigap Open Enrollment Window Whether you're inside your one-time guaranteed issue window for Medigap
Planning Medicare Savings Program Eligibility Whether your income qualifies you for help paying Medicare premiums and cost-sharing
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Medicare Questions About 

Medicare Advantage Special Needs Plan

 Plans

Understanding 

Medicare Advantage Special Needs Plan

Special Needs Plans are Medicare Advantage plans designed for people with specific situations. A D-SNP is for people who qualify for both Medicare and Medicaid. A C-SNP is for people with certain chronic conditions like diabetes, heart failure, or COPD. An I-SNP is for people who live in or require nursing care facilities.

D-SNPs — dual eligible special needs plans — are particularly important for low-income Medicare beneficiaries who also qualify for Medicaid. These plans coordinate your Medicare and Medicaid benefits, which means fewer separate claims and often lower or zero cost-sharing. Many D-SNPs include extra benefits like dental, vision, transportation, and over-the-counter allowances.

C-SNPs are designed around a specific condition. If you have one of the covered diagnoses, a C-SNP typically includes disease management programs, care coordinators, and formularies designed around the medications most commonly needed for that condition. Enrollment is restricted — you have to meet the eligibility criteria for the specific condition the plan covers.

Not all SNP types are available everywhere. In Utah, D-SNPs are offered in most counties, but the options vary by area. To find out what SNPs are available at your address, Medicare's Plan Finder at medicare.gov filters by plan type. If you're caring for a family member who might qualify for dual eligibility, connecting with your state's Medicaid office or a licensed Medicare advisor is a good first step.

Go to Plan Type
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Not sure if this plan is right for you?

Peter Abilla is a licensed Medicare agent. He can walk you through this plan's costs, coverage, and whether your doctors are in-network.

Independent agent. Not affiliated with any insurance carrier.
Elderly man smiling and showing yellow roses to a young boy in a sunlit garden.