Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Aetna Medicare Prime Chronic Care, 2027
H1206Contract004Plan
HMO C-SNP · special needs plan, chronic or disabling condition · 10 counties in Illinois
Run by Coventry Health Care of Illinois, Inc. (contract H1206), sold as Aetna Medicare, owned by CVS Health Corporation
Aetna Medicare Prime Chronic Care (H1206-004) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $7,150 ($6,750 in 2026). It takes in the members of H1206-009.
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| In-network out-of-pocket limit | $6,750 | $7,150 | ▲up $400 |
| Drug deductible | $200 | $700 | ▲up $500 |
| Skilled nursing facility, in network | $10 a day for days 1–20, then $218 a day for days 21–100 | $10 a day for days 1–20, then $221 a day for days 21–100 | ▲up $30for a 30-day stay |
| Eyewear, yearly limit | $200 a year | $100 a year | ▼down $100 |
| Drug tier 1, preferred generic | $2 | $5 | ▲up $3 |
| Drug tier 3, preferred brand | 25% of the cost | 22% of the cost | ▼down 3 points |
| Drug tier 4, non-preferred drug | 30% of the cost | 25% of the cost | ▼down 5 points |
| Drug tier 5, specialty tier | 30% of the cost | 25% of the cost | ▼down 5 points |
| 13 lines do not change | |||
| Monthly premium | $0 | $0 | no change |
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | $0 copay | $0 copay | no change |
| Specialist visit | $0 copay | $0 copay | no change |
| Emergency room | $130 copay | $130 copay | no change |
| Medical deductible, in network | none | none | no change |
| Hospital stay, in network | $375 a day for days 1–7, then $0 a day for days 8–90 | $375 a day for days 1–7, then $0 a day for days 8–90 | no change |
| Ground ambulance, in network | $290 copay | $290 copay | no change |
| Comprehensive dental, yearly limit | $2,500 a year | $2,500 a year | no change |
| Hearing aids, yearly limit for both ears | $750 a year | $750 a year | no change |
| Over-the-counter items, yearly | $480 a year | $480 a year | no change |
| Counties served | 10 | 10 | no change |
| Drug tier 2, generic | $12 | $12 | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026, standard pharmacy | 2027, standard pharmacy | 2027, preferred pharmacy |
|---|---|---|---|---|
| Tier 1 | Preferred Generic | $2 | $5 | $0 |
| Tier 2 | Generic | $12 | $12 | $5 |
| Tier 3 | Preferred Brand | 25% of the cost | 22% of the cost | 22% of the cost |
| Tier 4 | Non-Preferred Drug | 30% of the cost | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 30% of the cost | 25% of the cost | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 18 chronic or disabling condition special needs plans are sold for 2027, this one included. Against the others, 12 plans have a lower out-of-pocket limit, 5 a higher one. On the premium, 15 the same, 2 a higher one.
Out-of-pocket limits of the 18 chronic or disabling condition special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
The premium and the out-of-pocket limit are the same in all 10 counties: $0 a month and $7,150.
Illinois
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Which 2026 plans move into it, and what changes for their members?
For 2027 this plan takes in the members of 1 other plan, beside its own 1,437 members. In 2027 it costs $0 a month with a $7,150 limit; each row compares that with the plan its members had in 2026.
| 2026 plan | Members, Sept. 2026 | Members who move | Premium 2026 | Premium change | Limit 2026 | Limit change |
|---|---|---|---|---|---|---|
| Aetna Medicare Prime Chronic TotalH1206-009 | 416 | 407 | $15.20 | ▼down $15.20 | $9,250 | ▼down $2,100 |
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision). Each moving plan's own page lists every line that changes for its members.
Who runs this plan?
- Plan ID
- H1206-004
- Legal name of the contract
- Coventry Health Care of Illinois, Inc.
- Sold as
- Aetna Medicare
- Parent company
- CVS Health Corporation
- Plan type
- HMO C-SNP
- 2026 star rating of the contract
- not rated (too little data) overall; health plan not rated, drug plan 3 of 5
- Members, September 2026
- 1,437
- Plan website, as filed with CMS
- www.aetna.com/medicare
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Cook, ILWhere most of its members live; premiums and limits side by side
- Every Aetna Medicare plan for 2027Its contracts, counties and plans that end
- The other 7 plans of contract H1206Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.