Aetna Medicare Prime Care (HMO) in Dallas County, Texas — 2026 plan details
Last updated Jul 18, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Aetna Medicare Prime Care (HMO) (H4523-021) is a $0-premium Medicare Advantage HMO from CVS Health Corporation available in Dallas County, Texas in 2026, with a 4.0-star overall rating, a $4,200 in-network out-of-pocket maximum, and a $615 annual Part D drug deductible.
Plan facts (CMS CY2026 Landscape file)
| Organization | CVS Health Corporation |
|---|---|
| Plan name | Aetna Medicare Prime Care (HMO) |
| Contract ID | H4523 |
| Plan ID | 021 |
| Segment ID | 0 |
| Contract year | 2026 |
| Contract category | MA-PD |
| Plan type | HMO |
| SNP | No |
| Monthly consolidated premium | $0.00 |
| Part C premium | $0.00 |
| Part D basic premium | $0.00 |
| Part D total premium | $0.00 |
| Annual Part D deductible | $615.00 |
| Maximum out-of-pocket (in-network) | $4200.00 |
| Overall star rating | 4.0 |
How this plan is structured
- $0 consolidated premium. A $0 or near-$0 consolidated premium does not remove the Part B premium — the standard 2026 Part B premium is $202.90 per month and still applies. See the 2026 Medicare Part B premium.
- HMO plan type. In an HMO-style Medicare Advantage plan, in-network care and primary-care referral rules generally apply. See how Medicare Advantage HMO and PPO plans differ.
- $4,200 in-network out-of-pocket maximum. The MOOP is the annual cap on what a member pays in-network for covered Part A and Part B services. See how the Medicare Advantage MOOP works.
- Service area = Dallas County. Medicare Advantage plans are sold by service area; moving out of the plan's service area triggers a Special Enrollment Period to switch plans. See how moving changes your Medicare options.
How it compares in Dallas County
The CMS CY2026 Landscape file lists 93 Medicare Advantage plans in Dallas County, Texas, of which 0 carry a 5.0-star overall rating and 62 have a $0 consolidated monthly premium. Consolidated premiums range from $0.00 to $142.00 per month, and in-network out-of-pocket maximums range from $2299.00 to $9250.00.
For the full county plan directory, see all Medicare plans in Dallas County, Texas.
How to verify your doctors take this plan
Network participation changes throughout the year; we hold no provider-network data, so verify directly with these three sources before you decide:
- Open the plan's official Medicare.gov page and use its provider-directory link: Medicare.gov Plan Finder — H4523-021.
- Call the plan (CVS Health Corporation) using the member-services number listed on that plan page and ask whether each doctor, hospital, and pharmacy is in-network for 2026.
- Get free, unbiased help from your State Health Insurance Assistance Program (SHIP) — see free unbiased Medicare help from SHIP.
What H4523-021 means
CMS assigns every Medicare Advantage and Part D offering a plan identifier made of three parts. In H4523-021, the leading H marks the contract type (H = Medicare Advantage / Part C contract), the four digits 4523 are the contract number issued to the organization, and the three-digit 021 is the plan benefit package under that contract. The segment ID 0 identifies the service-area segment within the plan (0 = the default single segment).
Frequently asked questions
Is Aetna Medicare Prime Care (HMO) an HMO or PPO?
Aetna Medicare Prime Care (HMO) is an HMO — a Health Maintenance Organization-style Medicare Advantage plan, meaning in-network care and referral rules generally apply.
Does Aetna Medicare Prime Care (HMO) include prescription drug coverage?
Yes — Aetna Medicare Prime Care (HMO) is a Medicare Advantage plan with prescription drug coverage (MA-PD) and a $615.00 annual Part D drug deductible for 2026.
What is the maximum out-of-pocket cost for Aetna Medicare Prime Care (HMO)?
The 2026 in-network maximum out-of-pocket limit for Aetna Medicare Prime Care (HMO) is $4200.00, per the CMS CY2026 Landscape file.
What counties offer Aetna Medicare Prime Care (HMO) (H4523-021)?
Aetna Medicare Prime Care (HMO) (H4523-021) is offered in three Texas counties: Collin County, Dallas County, and Tarrant County.
Sources
- CMS, Plan Year 2026 Medicare Advantage & Part D Landscape source file (March 2026) — retrieved 2026-07-18. Overall star rating year: 2026.
- Medicare.gov Plan Finder — compare plans and enroll.