2027 Medicare Advantage plan

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

Aetna Medicare HMO C-SNP Special Needs Plan

CMS plan ID: H0628-033-0 · Plan year: 2027

Aetna Medicare Chronic Care Total (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$9,850.00

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: Same as Medicare's Part B deductible
Applies to certain in-network Medicare-covered services.
In-network medical maximum: $9,850.00
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

Plan-level deductibles may still apply when a service-specific deductible is listed as No.

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	0% to 20% coinsurance Service-specific deductible No	Approval required No Referral required No
Telehealth	$0.00 to $40.00 copay; 20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Emergency care	$115.00 copay
Urgent care	$40.00 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	20% coinsurance 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% to 20% coinsurance 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.
Care	Your share of the cost	What to know
Inpatient hospital stay	$2,241.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$2,091.00 copay per stay	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 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
Service	In-network	What to know
Outpatient hospital care	0% to 20% coinsurance Service-specific deductible No
Hospital observation services	20% coinsurance Service-specific deductible No
Ambulatory surgical center	0% to 20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	20% coinsurance Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	0% to 20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	0% to 20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	0% to 20% coinsurance 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% coinsurance 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
Service	In-network	What to know
Partial hospitalization	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Mental health, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	20% coinsurance 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	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	20% coinsurance Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	20% coinsurance 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	20% coinsurance 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
Service	In-network	What to know
Medicare-covered dental	20% coinsurance
Oral examsAdditional plan benefit	$0.00 copay
Dental X-raysAdditional plan benefit	$0.00 copay
Other diagnostic dentalAdditional plan benefit	$0.00 copay
Dental cleaningAdditional plan benefit	$0.00 copay
FluorideAdditional plan benefit	$0.00 copay
Other preventive dentalAdditional plan benefit	$0.00 copay
Restorative dental careAdditional plan benefit	$0.00 copay
Root canal treatment (endodontics)Additional plan benefit	$0.00 copay
Gum treatment (periodontics)Additional plan benefit	$0.00 copay
Removable dentures (prosthodontics)Additional plan benefit	$0.00 copay
Fixed dental restorations (prosthodontics)Additional plan benefit	$0.00 copay
Oral surgeryAdditional plan benefit	$0.00 copay
Other dental servicesAdditional plan benefit	$0.00 copay

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	0% to 20% coinsurance 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
Service	In-network	What to know
Medicare-covered hearing exams	20% coinsurance 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
Service	In-network	What 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 - Radiation/Radiation Oncology; Oncology - Medical, Surgical
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.

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

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.

Prescription drug coverage

Costs shown are for initial coverage.

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

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 tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	9%	9%	9%
Tier 4Non-Preferred Drug	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not 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.

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 tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$0.00	$0.00	$0.00
Tier 3Preferred Brand	9%	9%	9%
Tier 4Non-Preferred Drug	25%	25%	25%
Tier 5Specialty Tier	25%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	9%
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 tier	10 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	9%
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 29 county listings across 1 state or territory