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Aetna Medicare Assure Premier (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Assure Premier (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 Assure Premier (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Assure Premier (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 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Assure Premier (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 Assure Premier (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 Assure Premier (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 Assure Premier (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.70. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $590.00 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 $14000.00 (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 $14000.00 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 Assure Premier (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you'll pay the costs for your drugs based on the tier and pharmacy you use, until your total drug costs reach $2000. Once you reach $2000 in out-of-pocket drug costs, you will enter the catastrophic coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced monthly premium. During the catastrophic coverage phase, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Assure Premier (PPO D-SNP) plan offers a variety of benefits beyond standard Medicare coverage. The plan includes coverage for inpatient hospital stays with a $2030 copay per admission, outpatient services with 20% coinsurance, and emergency services with a $110 copay for emergencies. Additional benefits include preventive services like an annual physical exam with no copay and hearing services with no copay for hearing exams and prescription hearing aids up to $2000 per year. This plan also covers vision services, dental services, home infusion services, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but there is a $2030 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while Outpatient Blood Services also has a 20% coinsurance; outpatient substance abuse services have a 20% coinsurance for both individual and group sessions.
Partial Hospitalization See details
Aetna Medicare Assure Premier (PPO D-SNP) covers partial hospitalization with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered by this plan, with a 20% coinsurance for both. Transportation Services to a plan-approved health-related location are covered with no copay, and up to 48 one-way trips per year are allowed.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Aetna Medicare Assure Premier (PPO D-SNP) covers primary care services, including primary care physician services, with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, but routine care is not covered. Additional telehealth benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay for services such as Health Education, and Nutritional/Dietary Benefit, but the plan does not cover In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, and Counseling Services. The plan also covers wigs for hair loss related to chemotherapy with no copay and up to a $400 benefit per year. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay and at most 20% coinsurance for routine hearing exams. Prescription hearing aids (all types) are covered with no copay, but specific types of prescription hearing aids (inner ear, outer ear, and over the ear) are not covered. This plan provides a maximum of $2000 per year for prescription hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear benefits. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay; routine eye exams are limited to one per year. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have a 20% coinsurance, and contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum benefit of $450 per year.
Dental Services See details
The Aetna Medicare Assure Premier (PPO D-SNP) plan's dental services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, and other diagnostic and preventive services have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Assure Premier (PPO D-SNP) plan. This plan requires prior authorization, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Assure Premier (PPO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of at most 20% and Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%. There is no copay for any of these services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Assure Premier (PPO D-SNP) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Assure Premier (PPO D-SNP) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Assure Premier (PPO D-SNP) plan. The plan requires prior authorization for SNF services, and the copay information is available in the plan details.
Other Services See details
Other Services include coverage for over-the-counter items and meal benefits with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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