Aetna Medicare Longevity (HMO I-SNP)
Available to residents of Perry County, PA for 2026. Contract H3959, plan 066, segment 0.
- ✉ Email a copy of the plan benefit details
- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Perry County
- Plan website
- Browse the Aetna Medicare Longevity (HMO I-SNP) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $32.70 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $32.70? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $9,250.00? |
| Drug deductible | $615.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO I-SNP? |
| Special needs plan | Institutional SNP |
| Contract / plan | H3959-066-0 |
| Offered by | Aetna Medicare |
| Parent organization | CVS Health Corporation |
| Formulary drugs | 3,715 |
| Pharmacy search | www.aetnamedicare.com/findpharmacy |
| Member services | (833)859-6031TTY 711 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H3959 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | 20% coinsurance |
| Other health care professional | 20% coinsurance |
| Additional telehealth services | 20% coinsurance(authorization required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | Not covered |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 0%–20% coinsurance(authorization required) |
| Lab services | $0 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 0%–20% coinsurance(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | 20% coinsurance(authorization required) |
| Emergency and urgent care | |
| Emergency room | $115 copay |
| Urgent care | $40 copay |
| Worldwide emergency coverage | Not covered |
| Worldwide urgent care | Not covered |
| Worldwide emergency transportation | Not covered |
| Hospital care | |
| Inpatient hospital stay | Original Medicare cost-sharing(authorization required) |
| Outpatient hospital services | 0%–20% coinsurance(authorization required) |
| Outpatient observation | 20% coinsurance(authorization required) |
| Ambulatory surgical center | 0%–20% coinsurance(authorization required) |
| Outpatient blood services | 20% coinsurance |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–100 |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance(authorization required) |
| Rehabilitation | |
| Occupational therapy | $0 copay |
| Physical therapy and speech-language therapy | $0 copay |
| Cardiac rehabilitation | 20% coinsurance(authorization required) |
| Pulmonary rehabilitation | 20% coinsurance(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | Original Medicare cost-sharing(authorization required) |
| Outpatient mental health, individual session | 20% coinsurance(authorization required) |
| Outpatient mental health, group session | 20% coinsurance(authorization required) |
| Psychiatrist, individual session | 20% coinsurance(authorization required) |
| Psychiatrist, group session | 20% coinsurance(authorization required) |
| Partial hospitalization | 20% coinsurance(authorization required) |
| Intensive outpatient program | $110 copay(authorization required) |
| Outpatient substance use, individual session | 20% coinsurance(authorization required) |
| Outpatient substance use, group session | 20% coinsurance(authorization required) |
| Opioid treatment program | 20% coinsurance(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | 20% coinsurance(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | 20% coinsurance(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | 20% coinsurance |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | 20% coinsurance |
| Routine foot care | $0 copay(limits apply) |
| Dental? | |
| Medicare-covered dental services | 20% coinsurance(authorization required) |
| Preventive dental plan limit | $2,000 plan limit every year |
| Oral exams | $0 copay(limits apply) |
| Cleanings | $0 copay(limits apply) |
| Fluoride treatment | $0 copay |
| Dental x-rays | $0 copay(limits apply) |
| Other diagnostic dental services | $0 copay |
| Other preventive dental services | $0 copay |
| Restorative services (fillings, crowns) | $0 copay(limits apply) |
| Endodontics (root canals) | $0 copay(limits apply) |
| Periodontics (gum disease) | $0 copay(limits apply) |
| Dentures and other removable prosthodontics | $0 copay(limits apply) |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | $0 copay(limits apply) |
| Oral and maxillofacial surgery | $0 copay(limits apply) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay |
| Vision? | |
| Eye exam (Medicare-covered) | 20% coinsurance |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $250 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | 20% coinsurance |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aid plan limit | $750 plan limit every year |
| Hearing aids (all types) | $0 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $35 copay(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $255 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | Not covered |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | $0 copay(referral required) |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | 25% |
| Tier 2 | 25% |
| Tier 3 | 25% |
| Tier 4 | 25% |
| Tier 5 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 2: Generic | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 3: Preferred Brand | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | 25% | 25% | 25% |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 2: Generic | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 3: Preferred Brand | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 4: Non-Preferred Drug | 0% | 0% | 0% | 0% | 0% | 0% |
| Tier 5: Specialty Tier | 0% | 0% | 0% | 0% | 0% | 0% |
Also available in 66 other PA counties
- Adams
- Allegheny
- Armstrong
- Beaver
- Bedford
- Berks
- Blair
- Bradford
- Bucks
- Butler
- Cambria
- Cameron
- Carbon
- Centre
- Chester
- Clarion
- Clearfield
- Clinton
- Columbia
- Crawford
- Cumberland
- Dauphin
- Delaware
- Elk
- Erie
- Fayette
- Forest
- Franklin
- Fulton
- Greene
- Huntingdon
- Indiana
- Jefferson
- Juniata
- Lackawanna
- Lancaster
- Lawrence
- Lebanon
- Lehigh
- Luzerne
- Lycoming
- McKean
- Mercer
- Mifflin
- Monroe
- Montgomery
- Montour
- Northampton
- Northumberland
- Philadelphia
- Pike
- Potter
- Schuylkill
- Snyder
- Somerset
- Sullivan
- Susquehanna
- Tioga
- Union
- Venango
Benefits in plain text
Aetna Medicare Longevity (HMO I-SNP) (H3959-066-0) is a 2026 HMO I-SNP Medicare Advantage plan offered by Aetna Medicare, available to residents of Perry County, PA.
The monthly premium is $32.70 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $9,250.00.
The drug deductible is $615.00.
It is a special needs plan (Institutional SNP).
The plan's formulary lists 3,715 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: 25%; tier 2: 25%; tier 3: 25%; tier 4: 25%; tier 5: 25%.
CMS gives the plan's contract (H3959) an overall rating of 4 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.