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Aetna Medicare Dual Preferred (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Preferred (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 Preferred (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern West Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Preferred (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 Preferred (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 Preferred (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 Preferred (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.20. 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 Preferred (PPO D-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, the plan's premium is $30.20. After you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Dual Preferred (PPO D-SNP) plan offers comprehensive coverage with a focus on affordability. This plan includes no copay for many essential services like preventive care, home health, and hearing exams. Additional benefits include coverage for outpatient services, primary care, vision and dental services, and medical equipment, often with a coinsurance of 20%.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. The copay for a Medicare-covered stay is $2150 for Inpatient Hospital-Acute and $2036 for Inpatient Hospital Psychiatric, per admission or per stay. Additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under this plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance, while outpatient blood services have a 20% coinsurance and individual and group sessions for outpatient substance abuse have a minimum of 20% and a maximum of 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a minimum coinsurance of 20% and a maximum coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (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 Preferred (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered with no copay for up to 12 one-way trips per year, but other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Dual Preferred (PPO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a 20% coinsurance, Chiropractic Services with a 20% coinsurance (excluding Routine Care), Occupational Therapy Services with 20% coinsurance, Physician Specialist Services with 0% to 20% coinsurance, Mental Health Specialty Services with 20% coinsurance for individual and group sessions, Podiatry Services with 20% coinsurance (Routine Foot Care) and no copay for Medicare-covered podiatry services, Other Health Care Professional with 0% to 20% coinsurance, Psychiatric Services with 20% coinsurance for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with 20% coinsurance, Additional Telehealth Benefits with 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with 20% coinsurance.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, home and bathroom safety devices and modifications, and wigs for hair loss related to chemotherapy. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit with a 20% coinsurance. Some services, like in-home safety assessments and counseling services, are not covered.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with no copay, and a coinsurance of at most 20% for routine hearing exams. Prescription hearing aids are covered with no copay, up to a maximum of $1250 per ear every year, while OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance for routine eye exams and no copay. Eyewear is covered with a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers Medicare dental services with 20% coinsurance and other dental services with a $2,500 maximum benefit every year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while 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 Preferred (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Preferred (PPO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with 20% coinsurance and authorization required, and prosthetic devices and medical supplies with 20% coinsurance and authorization required. Diabetic supplies have no copay, while diabetic therapeutic shoes/inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Dual Preferred (PPO D-SNP) plan. Diagnostic procedures and tests, as well as lab services, have no copay, and a coinsurance of up to 20%. Radiological services have no copay, and a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Preferred (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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is coinsurance for some services, but specific cost-sharing details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered. Prior authorization is required, and the copay information is available in the plan details.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, and other services such as annual wellness exams and screening mammography, and gFOBT/FIT with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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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