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Aetna Medicare Dual Extra (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra (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 Extra (PPO D-SNP) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Dual Extra (PPO D-SNP) is a PPO D-SNP plan offered by Coventry Health and Life Insurance Company available for the 2026 plan year to people living in Select Counties Statewide in AR. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra (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 Extra (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 Extra (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 Extra (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
Health deductible: same as Medicare's Part B deductible.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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:
Sign up for Aetna Medicare Dual Extra (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Aetna Medicare Dual Extra (PPO D-SNP) offers an Enhanced Alternative drug benefit with a prescription drug deductible of $615.00. If you qualify for the low-income subsidy, also known as Extra Help, your Part D premium is reduced to $0. During the initial coverage phase, you will have no copay for Tier 1 preferred generic drugs at standard pharmacies. For other drug tiers at standard pharmacies, you will pay a 22% coinsurance for Tier 2 standard generics, and a 25% coinsurance for Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The Aetna Medicare Dual Extra (PPO D-SNP) offers comprehensive medical coverage, with many outpatient, specialist, and primary care services requiring no copay and a 20% coinsurance. Inpatient hospital stays require a $1,750 copay per stay with no coinsurance, while emergency care features a $115 copay. Additionally, routine preventive care, home health services, and up to 24 one-way transportation trips per year are covered with no copay and no coinsurance. For extra lifestyle benefits, the plan provides a $1,500 annual limit for dental care and up to $500 per ear annually for prescription hearing aids, both with no copay and no coinsurance. Members also receive a $105 monthly allowance for over-the-counter items, alongside no-copay vision exams and select wellness benefits. Medical equipment, diabetic shoes, and dialysis services are also covered under the plan, requiring no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Dual Extra (PPO D-SNP), requiring a $1,750 copay per stay and no coinsurance for covered acute and psychiatric admissions. While unlimited additional acute days are covered with no copay, non-Medicare-covered stays, acute upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with no copay and a 20% coinsurance. Covered services include outpatient hospital visits, observation services, ambulatory surgical center services, outpatient substance abuse treatment, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Aetna Medicare Dual Extra (PPO D-SNP) plan and require prior authorization. Members are responsible for a $110 copay or a 20% coinsurance for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Aetna Medicare Dual Extra (PPO D-SNP) plan, with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance. Additionally, worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Dual Extra (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with a 20% coinsurance and no copay. Additional telehealth services are offered with no copay, while routine chiropractic and podiatry care are covered with a 20% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra (PPO D-SNP), offering annual physicals, fitness benefits, and personal emergency response systems with no copay and no coinsurance, while kidney disease education and select screenings require a 20% coinsurance and no copay. Sub-services that are not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Extra (PPO D-SNP) provides partially covered hearing services, including one annual routine hearing exam with a 20% coinsurance and no copay, and one annual fitting evaluation with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers vision services with no deductible and no copayments for eye exams and eyewear. Routine eye exams and contact lenses require a 20% coinsurance, while other services have no coinsurance, up to an annual maximum of $50 for exams and a combined $350 for eyewear.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Extra (PPO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a 20% coinsurance and no copay, while other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $1,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with prior authorization required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Extra (PPO D-SNP), with durable medical equipment, prosthetic devices, and diabetic shoes requiring a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for most of these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with no copays, although prior authorization is required. Coinsurance for these services ranges from no coinsurance up to 20% depending on the specific diagnostic, lab, or radiological service.
Home Health Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Extra (PPO D-SNP) does not cover Cardiac Rehabilitation Services. There is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. The benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, and prior authorization is required.
Other Services See details
Other Services are partially covered by Aetna Medicare Dual Extra (PPO D-SNP), with acupuncture and Dual Eligible SNPs with Highly Integrated Services not covered. Covered benefits, including a $105 monthly over-the-counter allowance, chronic illness meals, and select wellness exams, are offered with no copay and no coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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