Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
Aetna Medicare QMB Only Extra Care, 2027
H4523Contract041Plan
HMO D-SNP · special needs plan, dual-eligible · 98 counties in Texas
Run by Aetna Health Inc. (TX) (contract H4523), sold as Aetna Medicare, owned by CVS Health Corporation
Aetna Medicare QMB Only Extra Care (H4523-041) costs $0 a month in 2027, down $4.60 from 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026). In 2026 it was called Aetna Medicare Partial Dual Care. It leaves 8 counties it served in 2026; they choose another plan for 2027 (the counties are listed below).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Plan name | Aetna Medicare Partial Dual Care | Aetna Medicare QMB Only Extra Care | renamed |
| Monthly premium | $4.60 | $0 | ▼down $4.60 |
| In-network out-of-pocket limit | $9,250 | $9,850 | ▲up $600 |
| Drug deductible | $615 | $700 | ▲up $85 |
| Emergency room | $110 copay | $115 copay | ▲up $5 |
| Hospital stay, in network | $1,650 a stay | $2,015 a stay | ▲up $365for a 5-day stay |
| Skilled nursing facility, in network | not filed | $0 a day for days 1–20, then $221 a day for days 21–100 | changed |
| Over-the-counter items, yearly | $1,080 a year | $1,320 a year | ▲up $240 |
| Counties served | 80 | 98 | ▲up 18 |
| Drug tier 2, generic | $10 | $0 | ▼down $10 |
| Drug tier 3, preferred brand | 22% of the cost | 9% of the cost | ▼down 13 points |
| 11 lines do not 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 |
| Medical deductible, in network | none | none | no change |
| Ground ambulance, in network | 20% of the cost | 20% of the cost | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Eyewear, yearly limit | $300 a year | $300 a year | no change |
| Hearing aids, yearly limit for both ears | $2,000 a year | $2,000 a year | no change |
| Drug tier 1, preferred generic | $0 | $0 | no change |
| Drug tier 4, non-preferred drug | 25% of the cost | 25% of the cost | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% of the cost | 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 | 2027 |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0 | $0 |
| Tier 2 | Generic | $10 | $0 |
| Tier 3 | Preferred Brand | 22% of the cost | 9% of the cost |
| Tier 4 | Non-Preferred Drug | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 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, 77 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 8 plans have a lower out-of-pocket limit, 68 the same. On the premium, 69 the same, 7 a higher one.
Out-of-pocket limits of the 77 dual-eligible 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?
It stops serving 8 counties it served in 2026 (listed in the next section).
The premium and the out-of-pocket limit are the same in all 98 counties: $0 a month and $9,850.
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
What if you live in a county it leaves?
Its 2026 members in the 8 counties listed below cannot stay in it for 2027; each county page lists the 2027 plans sold there.
- Your coverage
- This plan ends for you on December 31, 2026, because it is no longer sold where you live.
- October 15 to December 7, 2026
- Open enrollment: join another Medicare Advantage plan, or Original Medicare with a drug plan. Coverage starts January 1, 2027.
- December 8, 2026 to the end of February 2027
- A special enrollment period because the plan is leaving: you can still join a plan, but coverage starts the first day of the month after you join, so choose by December 31 to have no gap.
- If you do nothing
- You are enrolled in Original Medicare when the plan ends, and because you have Medicaid, Medicare enrolls you in a drug plan.
- If you choose Original Medicare
- You have a guaranteed right to buy Medigap Plan A, B, C, D, F, G, K or L sold in your state by any insurance company; if you were new to Medicare on or after January 1, 2020, Plans D and G take the place of C and F. Apply from 60 days before to 63 days after the plan ends; the policy starts once your Medicare Advantage coverage ends. Other Medigap plans are not covered by this right.
- If you have Medicaid or Extra Help
- You can switch to a different drug plan, or leave a Medicare Advantage plan for Original Medicare with a drug plan, once a calendar month; the change starts the first day of the next month.
| County | Members, Sept. 2026 |
|---|---|
| Bowie, TX | fewer than 11 |
| Cherokee, TX | fewer than 11 |
| Colorado, TX | fewer than 11 |
| DeWitt, TX | fewer than 11 |
| Hamilton, TX | fewer than 11 |
| Henderson, TX | fewer than 11 |
| Randall, TX | fewer than 11 |
| Smith, TX | fewer than 11 |
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); Medicare.gov, “Special enrollment periods” and “When can I buy Medigap?” (read Oct. 7, 2026).
Who runs this plan?
- Plan ID
- H4523-041
- Legal name of the contract
- Aetna Health Inc. (TX)
- Sold as
- Aetna Medicare
- Parent company
- CVS Health Corporation
- Plan type
- HMO D-SNP
- 2026 star rating of the contract
- 4 of 5 overall; health plan 4 of 5, drug plan 3.5 of 5
- Members, September 2026
- 361
- 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 Bexar, TXWhere 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 23 plans of contract H4523Same 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.