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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.
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 (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 (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 $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
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 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 (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 (PPO D-SNP) plan features an Enhanced Alternative prescription drug benefit with an annual drug deductible of $615. If you qualify for the low-income subsidy, also known as Extra Help, you will have no premium for your Part D coverage. During the initial coverage phase at a standard pharmacy, you will pay a $10 copay for preferred generic drugs, 22% coinsurance for standard generics, and 25% coinsurance for both preferred brand and non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you will transition to the catastrophic coverage phase and pay nothing for your covered Part D prescription drugs.
Additional Benefits
The Aetna Medicare Dual (PPO D-SNP) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care visits, telehealth, and home health services. For hospital care, inpatient stays require a daily copay of $380 for the first seven days of acute care, while outpatient hospital services carry copays up to $380. Emergency room visits have a $115 copay, which is waived if you are admitted, while urgently needed services require a $15 copay. Members also benefit from no copays and no coinsurance for routine dental and vision care up to annual limits, alongside a $45 monthly over-the-counter allowance. Routine hearing exams and prescription hearing aids are covered with no copays, while dialysis, durable medical equipment, and prosthetic devices require a 20% coinsurance. Skilled nursing facility care is fully covered with no copay for the first 20 days, followed by a daily copay of $218 for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Dual (PPO D-SNP) with no coinsurance, requiring a daily copay of $380 for days 1 to 7 of acute care and $678 for days 1 to 3 of psychiatric care, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual (PPO D-SNP) covers outpatient services with no copay or coinsurance for ambulatory surgical center and blood services. Outpatient hospital and observation services require prior authorization and have copays ranging up to $380 with no coinsurance, while outpatient substance abuse treatment requires a $40 copay for individual sessions or 20% coinsurance for group sessions.
Partial Hospitalization See details
Aetna Medicare Dual (PPO D-SNP) covers partial hospitalization benefits with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Dual (PPO D-SNP) covers ground ambulance services with a $280 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services feature no copay and no coinsurance up to a $250,000 maximum limit.
Primary Care See details
Aetna Medicare Dual (PPO D-SNP) covers primary care visits, routine chiropractic care, and telehealth services with no copay and no coinsurance. Other covered services, including specialist visits, occupational and physical therapy, and mental health sessions, require copays ranging from $15 to $40 with no coinsurance.
Preventive Services See details
Aetna Medicare Dual (PPO D-SNP) offers partial coverage for preventive services, featuring no copay and no coinsurance for annual physicals, health education, and various screenings. However, kidney disease education services require a 20% coinsurance with no copay, and several supplemental benefits like weight management and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Dual (PPO D-SNP) covers hearing exams with a $25 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered under Aetna Medicare Dual (PPO D-SNP) with no coinsurance, offering eye exams with copays ranging from no copay to $25 and a $50 annual limit. Additionally, eyewear is covered with no copay and no coinsurance up to a $200 yearly maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual (PPO D-SNP), with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Medicare-covered dental services require a $25 copay and no coinsurance, while other covered preventive and comprehensive services feature no copay and no coinsurance up to a $1,000 yearly limit.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered under Aetna Medicare Dual (PPO D-SNP), as Part D home infusion drugs are not covered. Covered Part B insulin requires a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Dual (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Dual (PPO D-SNP) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual (PPO D-SNP), with prior authorization required for these services. Lab services and outpatient x-rays are available with no copay or coinsurance, while other diagnostic tests carry a copay between $0 and $95 with no coinsurance. Diagnostic and therapeutic radiological services require up to 20% coinsurance, with diagnostic radiology also subject to a copay.
Home Health Services See details
Aetna Medicare Dual (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Dual (PPO D-SNP) plan, as all sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Dual (PPO D-SNP) with prior authorization, featuring no copay and no coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100. A prior three-day hospital stay is not required, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual (PPO D-SNP) offers partially covered other services with no copay and no coinsurance, including a $45 monthly over-the-counter allowance, chronic illness meal benefits, and select wellness exams. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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