2027 Medicare Advantage plan

Aetna Medicare Chronic Care (HMO C-SNP): 2027 benefits and costs

Aetna Medicare HMO C-SNP Special Needs Plan

CMS plan ID: H0628-036-0 · Plan year: 2027

Aetna Medicare Chronic Care (HMO C-SNP) is a 2027 Medicare Advantage plan offered by Aetna Medicare. It is listed in Ohio.

2027 plan costs at a glance

Monthly plan premium$0.00
Drug deductible$700.00
In-network medical out-of-pocket maximum$7,150.00
Organization
Aetna Medicare
Plan organization
AETNA HEALTH OF OHIO INC.
Parent company
CVS Health Corporation
Plan type
HMO C-SNP
Part C premium
$0.00
Part D premium
$0.00
Prescription drug coverage
Yes
Special Needs Plan type
Chronic or Disabling Condition
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
In-network medical maximum
$7,150.00

Applies to certain in-network supplemental services.

Who can join this Special Needs Plan?

This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.

Plan eligibility type
Chronic or Disabling Condition
Qualifying conditions
Diabetes Mellitus, Chronic Heart Failure, and Cardiovascular Disorders

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0.00 copay

Service-specific deductible
No
Specialist visit

$0.00 to $25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Telehealth

$0.00 to $50.00 copay; 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Emergency care

$130.00 copay

Urgent care

$50.00 copay

Home health

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

20% coinsurance

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered foot care

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Other health professionals

$0.00 to $25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–6: $325.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–6: $325.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $10.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $325.00 copay

Service-specific deductible
No
Hospital observation services

$325.00 copay

Service-specific deductible
No
Ambulatory surgical center

$0.00 to $275.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Outpatient blood

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0.00 to $20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Laboratory services

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0.00 to $195.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
X-rays

$20.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$60.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Opioid treatment program

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Physical and speech therapy

$25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Cardiac rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Intensive cardiac rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Pulmonary rehabilitation

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Supervised exercise for peripheral artery disease

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$250.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

0% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

$0.00 copay

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

0% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$25.00 copay

Oral examsAdditional plan benefit

$0.00 copay

Dental X-raysAdditional plan benefit

$0.00 copay

Dental cleaningAdditional plan benefit

$0.00 copay

Restorative dental careAdditional plan benefit

20% to 50% coinsurance

Root canal treatment (endodontics)Additional plan benefit

20% coinsurance

Gum treatment (periodontics)Additional plan benefit

20% to 50% coinsurance

Removable dentures (prosthodontics)Additional plan benefit

50% coinsurance

Fixed dental restorations (prosthodontics)Additional plan benefit

50% coinsurance

Oral surgeryAdditional plan benefit

20% to 50% coinsurance

Other dental servicesAdditional plan benefit

20% to 50% coinsurance

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0.00 to $25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Medicare-covered eyewear

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$25.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Routine hearing examsAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0.00 copay

Approval required
No
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Annual physical examAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Allowances and optional benefits

EBC OTC-ESW Combined Allowance

One shared limit covers the listed services, not a separate allowance for each service.

Full allowance details are not summarized here.

Benefits for qualifying members

Cancer Care

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Other 1
Qualifying conditions
Cancer
To qualify
High value provider
Covered package services cost $0 until the package limit is reached
No
Benefits that apply to reduced cost sharing
Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing
Physician Specialist Services; Additional Telehealth Benefits
Does your MA Uniformity Flexibility/SSBCI cost reduction cover all or some Specialists under Physician Specialist Services?
Some specialists
Some package benefits are exempt from the deductible
Yes
Benefits that apply to being exempt from the plan-level deductible
Medicare-covered benefits
Medicare benefits that are exempt from the plan level deductible
Physician Specialist Services; Additional Telehealth Benefits
Do you offer reduced Coinsurance?
No
Service-specific deductible
No
Reduced Copayment?
Yes
Types of benefits that apply to the copayment cost sharing
Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment
Additional Telehealth Benefits
Minimum Copayment for Additional Telehealth Benefits
$0.00
Maximum Copayment for Additional Telehealth Benefits
$0.00
Specialists reduced coinsurance?
No
Specialists reduced copayment?
Yes
Specialists with the reduced copayment
Oncology - Medical, Surgical; Oncology - Radiation/Radiation Oncology
Minimum Copayment Amount for Oncology - Medical, Surgical
$0.00
Maximum Copayment Amount for Oncology - Medical, Surgical
$0.00
Minimum Copayment Amount for Oncology - Radiation/Radiation Oncology
$0.00
Maximum Copayment Amount for Oncology - Radiation/Radiation Oncology
$0.00

Full package terms are not summarized here.

SSBCI Pkg

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Cardiovascular disorders; Chronic heart failure; Diabetes mellitus
To qualify
High value provider
Included services
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Some package benefits are exempt from the deductible
Yes
Services exempt from the deductible
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Package limit
$30.00
How often this limit applies
Every month
How benefits are provided
Debit Card
Services sharing the package limit
Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit

Full package terms are not summarized here.

Recovery at Home Program

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions
Other 5; Congestive Heart Failure (CHF); Other 1; Other 2; Other 3; Other 4
Qualifying conditions
Fractures
Qualifying conditions
Neurologic Disorders
Qualifying conditions
Musculoskeletal (MSK)
Qualifying conditions
Pneumonia
Qualifying conditions
Urologic Conditions
All listed conditions required
No
Combination of conditions required
No
To qualify
Participation in a Care Management Program
Included services
In-Home Support Services
Some package benefits are exempt from the deductible
Yes
Services exempt from the deductible
In-Home Support Services

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$5.00

$10.00

$15.00

Tier 3Preferred Brand

22%

22%

22%

Tier 4Non-Preferred Drug

25%

25%

25%

Tier 5Specialty Tier

25%

Not listedNot listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$5.00

$10.00

$15.00

Tier 2Generic

$12.00

$24.00

$36.00

Tier 3Preferred Brand

22%

22%

22%

Tier 4Non-Preferred Drug

25%

25%

25%

Tier 5Specialty Tier

25%

Not listedNot listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, but the number of days you can fill is limited. Check the supply lengths below and the plan’s out-of-network rules.

Preferred mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$0.00

$0.00

$0.00

Tier 2Generic

$5.00

$5.00

$5.00

Tier 3Preferred Brand

22%

22%

22%

Tier 4Non-Preferred Drug

25%

25%

25%

Tier 5Specialty Tier

25%

Not listedNot listed

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier30 days60 days100 days
Tier 1Preferred Generic

$5.00

$10.00

$15.00

Tier 2Generic

$12.00

$24.00

$36.00

Tier 3Preferred Brand

22%

22%

22%

Tier 4Non-Preferred Drug

25%

25%

25%

Tier 5Specialty Tier

25%

Not listedNot listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier31 days
Tier 1Preferred Generic

$5.00

Tier 2Generic

$12.00

Tier 3Preferred Brand

22%

Tier 4Non-Preferred Drug

25%

Tier 5Specialty Tier

25%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier10 days
Tier 1Preferred Generic

$5.00

Tier 2Generic

$12.00

Tier 3Preferred Brand

22%

Tier 4Non-Preferred Drug

25%

Tier 5Specialty Tier

25%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 2: Generic

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 3: Preferred Brand

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 4: Non-Preferred Drug

Drugs included in this tier
Part D Drugs Only
Longer fills available for every covered drug
Yes
Some longer-fill prescriptions require a one-month first fill
No

Tier 5: Specialty Tier

Drugs included in this tier
Part D Drugs Only
Initial-coverage prices also apply to drugs exempt from the deductible
Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 21 county listings across 1 state or territory

Ohio