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Aetna Medicare Dual (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Dual (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in South Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Medicare Dual (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Dual (PPO D-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Dual (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.50. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Dual (PPO D-SNP) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month fills at standard pharmacies and standard mail order. Tier 2 generic medications require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, Tier 3 preferred brand drugs require a 22% coinsurance for all supply durations. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply. These clear cost-sharing tiers help you understand your out-of-pocket expenses for prescription drugs under this Medicare plan.
Additional Benefits
The Aetna Medicare Dual (PPO D-SNP) plan offers comprehensive medical coverage with a mix of copays and coinsurance depending on the service. Inpatient hospital stays require a $1,780 copayment per stay with no coinsurance, while outpatient services generally feature no copay but require a 20% coinsurance. Emergency care is available with a $115 copay, which is waived if you are admitted, and primary care visits feature no copay alongside a 20% coinsurance. For supplemental care, members enjoy no copays or coinsurance for preventive services, home health care, and telehealth visits. Vision, dental, and hearing benefits feature no copays, though a 20% coinsurance applies to certain routine services, and the plan includes annual allowances like $1,500 for prescription hearing aids and $300 for eyewear. Additionally, the plan provides practical extra benefits with no copay or coinsurance, including a $60 monthly over-the-counter allowance.
Inpatient Hospital See details
Aetna Medicare Dual (PPO D-SNP) partially covers inpatient hospital services with a $1,780 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric stays, both of which require prior authorization. While unlimited additional days for acute care are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Dual (PPO D-SNP) covers outpatient services with no copay, but a 20% coinsurance applies to outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for the first three pints of blood.
Partial Hospitalization See details
Aetna Medicare Dual (PPO D-SNP) covers partial hospitalization services with no copay, though a 20% or 30% coinsurance applies and prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Dual (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Dual (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Dual (PPO D-SNP) covers primary care, specialist, therapy, mental health, and psychiatric services with no copay and a 20% coinsurance. Routine chiropractic care is not covered, podiatry and other professional services feature no copay and range from no coinsurance to 20% coinsurance, and telehealth benefits have no copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under Aetna Medicare Dual (PPO D-SNP), offering an annual physical exam, fitness benefits, and health education with no copay and no coinsurance, while kidney disease education and glaucoma screenings have a 20% coinsurance and no copay. However, several sub-services are not covered, including in-home safety assessments, medical nutrition therapy, weight management programs, and therapeutic massage.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual (PPO D-SNP), offering routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,500 annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual (PPO D-SNP) covers vision services with no deductibles, offering no copays for exams and eyewear, though a 20% coinsurance applies to routine eye exams and contact lenses. The plan provides up to $50 annually for eye exams and a $300 yearly allowance for eyewear benefits like glasses and contacts.
Dental Services See details
Aetna Medicare Dual (PPO D-SNP) provides partially covered dental services, featuring no copay and 20% coinsurance for Medicare-covered dental services, and no copay and no coinsurance for other dental services up to a $1,275 yearly limit. While most preventive and comprehensive services are included, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual (PPO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual (PPO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual (PPO D-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Members will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Dual (PPO D-SNP) with no copays, though prior authorization is required. You will pay a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiology, and outpatient X-rays, while diagnostic radiological services are covered with no coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual (PPO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Dual (PPO D-SNP) with no copay, although only some services are covered in practice; standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual (PPO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Dual (PPO D-SNP) with no copay and no coinsurance, including a $60 monthly reimbursement for over-the-counter items, chronic illness meals, and wellness exams. Acupuncture is not covered under this benefit.
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