Aetna Medicare Assure Primary (HMO D-SNP)
South Carolina Medicare-Medicaid Dual Eligible D-SNP Plan (2025 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
4.0
out of 5 stars
Plan Name
Aetna Medicare Assure Primary (HMO D-SNP)
Plan Type
Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP)
Aetna Medicare Assure Primary (HMO D-SNP) is a Medicare-Medicaid Dual Eligible Medicare Advantage Plan (D-SNP), which is available in South Carolina and offered by the health insurance company Aetna Medicare. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$0 copay
Aetna Medicare Assure Primary (HMO D-SNP) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $9,350 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Aetna Medicare Assure Primary (HMO D-SNP) are defined below.
Yes
Part D Prescription Drug Coverage
Aetna Medicare Assure Primary (HMO D-SNP) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Aetna Medicare Assure Primary (HMO D-SNP) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Aetna Medicare Assure Primary (HMO D-SNP) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Aetna Medicare Assure Primary (HMO D-SNP) received an overall government quality rating of 4.0 stars out of 5 stars.
Aetna Medicare Assure Primary (HMO D-SNP) performed better than South Carolina’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
South Carolina State Average Score
Overall Government 5 Star Quality Rating
4.0
3.8
Summary rating of health plan quality
Staying healthy: screenings, tests, & vaccines
Managing chronic (long term) conditions
Member experience with health plan
Member complaints & changes in the health plan's performance
Health plan customer service
Summary rating of drug plan quality
Drug plan customer service
Member complaints & changes in the drug plan's performance
Member experience with the drug plan
Drug safety & accuracy of drug pricing
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Aetna Medicare Assure Primary (HMO D-SNP) received 4 stars for its health plan quality score which is better than the South Carolina State average health plan quality score of 3.7 stars.
Aetna Medicare Assure Primary (HMO D-SNP) received 4 stars for its drug plan quality score which is better than the South Carolina State average drug plan quality score of 3.7 stars.
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Hospital Services
Inpatient hospital coverage
Outpatient hospital coverage
Skilled nursing facility
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
Prosthetics (like braces, artificial limbs)
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Catastrophic coverage phase |
---|
Preferred Generic |
Generic drugs :
25% coinsurance Brand-name drugs :
25% coinsurance |
Generic drugs :
0% coinsurance Brand-name drugs :
0% coinsurance |
Generic |
Preferred Brand |
Non-Preferred Drug |
Specialty Tier |
Part B Drugs
Hearing
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: $0 copay
Cleaning
In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays
In-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Prosthodontics, removable
Maxillofacial prosthetics
Oral and maxillofacial surgery
Adjunctive general services
Vision
Eyeglasses (frames & lenses)
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