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Aetna Medicare Dual Choice (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Choice (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 Choice (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Choice (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in AR - Statewide. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Choice (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 Choice (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 Choice (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 Choice (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.60. 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 $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 Dual Choice (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay the costs for your drugs based on the tier. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Dual Choice (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $1595 copay per admission, while outpatient services and partial hospitalization have a 20% coinsurance. Emergency services have a copay, and many services like primary care, hearing, and vision, have either no copay or a 20% coinsurance. Additional perks include no copays for transportation to health-related locations, preventive services like annual physical exams, routine hearing exams, and certain dental services. The plan also covers OTC items and offers a meal benefit with no copay, and prescription hearing aids are covered up to $500 per year with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. The copay for a Medicare-covered stay is $1595 per admission or stay, and additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, 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 and observation services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance with a waived three-pint deductible. Individual and group sessions for outpatient substance abuse services have a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Dual Choice (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay and are limited to 48 one-way trips per year, using rideshare services, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Aetna Medicare Dual Choice (PPO D-SNP) with a $110 copay, and Urgently Needed Services have a $45 copay. Worldwide Emergency Services are also covered, with Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each having no copay.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Occupational Therapy Services, Individual and Group Sessions for Mental Health and Psychiatric Services, and Opioid Treatment Program Services are covered with a 20% coinsurance. Chiropractic Services and Podiatry Services are covered with a 20% coinsurance, with routine chiropractic care having no copay, and routine foot care having no coinsurance, but other podiatry services have a copay. Additional Telehealth Benefits have no copay.
Preventive Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a 20% coinsurance, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams, with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids are covered up to $500 per year with no copay, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers vision services including eye exams and eyewear. Eye exams have a 20% coinsurance, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, also have a 20% coinsurance, but there is no copay. There is a combined maximum benefit of $300 every year for eyewear.
Dental Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers dental services with a 20% coinsurance for Medicare dental services, and other dental services have a maximum benefit of $2,750 per year. Oral exams, X-Rays, other diagnostic services, cleanings, fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed) and oral surgery have no copay. Maxillofacial prosthetics, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Dual Choice (PPO D-SNP) plan. This includes 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.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance for Medicare-covered items. Diabetic supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. For Diagnostic Procedures/Tests and Lab Services, you pay at most 20% coinsurance. For Diagnostic Radiological Services, you pay no coinsurance. For Therapeutic Radiological Services and Outpatient X-Ray Services, you pay at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Choice (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 covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan, however, the plan does not specify any cost sharing details. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered stays. Prior authorization is required, and the copay is determined by Medicare.
Other Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $165.00 per month; it also covers a meal benefit 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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