A non-government entity
Aetna Medicare Full Dual (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full 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 Full Dual (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2026 to people living in South Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full 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 Full 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 Full 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 Full Dual (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.50. 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 $615.00 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 $13900.00 (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 $13900.00 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:
Sign up for Aetna Medicare Full Dual (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Full Dual (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic prescriptions, members pay no copay for one-month, two-month, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic medications require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher tier medications under this plan are subject to coinsurance at standard pharmacies and standard mail order services. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all supply lengths. Tier 5 specialty tier drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Medicare Full Dual (PPO D-SNP) provides robust coverage for essential medical needs, featuring inpatient hospital stays with fixed copayments and no coinsurance, as well as outpatient and primary care services with no copay and a 20% coinsurance. Emergency care is available with a $115 copay, and skilled nursing facility stays are covered with no copay for the first 20 days. Home health services are also fully covered with no copay and no coinsurance. For supplemental care, the plan offers dental, vision, and hearing benefits with no copays and generous annual limits, though certain routine exams are subject to a 20% coinsurance. Members also receive a $150 monthly over-the-counter allowance and diagnostic services with no copay. Durable medical equipment and prosthetics are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Aetna Medicare Full Dual (PPO D-SNP) covers inpatient hospital services with no coinsurance, requiring a copayment of $2,230 per stay for acute care and $2,080 per stay for psychiatric care. This benefit is partially covered, as prior authorization is required, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, substance abuse, and blood services—with no copay and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Full Dual (PPO D-SNP) plan with no copay, although a 20% or 30% coinsurance and prior authorization are required.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under Aetna Medicare Full Dual (PPO D-SNP) are covered with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no copay and no coinsurance.
Primary Care See details
Aetna Medicare Full Dual (PPO D-SNP) covers primary care, specialist, therapy, psychiatric, and opioid treatment services with no copay and a 20% coinsurance. Chiropractic services are only partially covered as routine care is excluded, while telehealth benefits feature no copay and no coinsurance. Podiatry and other professional services are covered with no copay and a coinsurance ranging from 0% to 20%.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Full Dual (PPO D-SNP), featuring an annual physical and several supplemental benefits with no copay and no coinsurance, alongside kidney education and glaucoma screenings with no copay and 20% coinsurance. However, sub-services such as In-Home Safety Assessments, Medical Nutrition Therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by the Aetna Medicare Full Dual (PPO D-SNP) with no deductible, offering routine exams and fitting evaluations once per year with no copay, though routine exams carry a 20% coinsurance. Prescription hearing aids are covered up to $2,000 per ear annually with no copay or coinsurance, but OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no deductibles, featuring no copay for routine and follow-up diabetic eye exams up to a $50 annual maximum, though a 20% coinsurance applies to routine exams. Eyewear is also covered with no copay for contacts, eyeglasses, frames, and upgrades up to a $325 yearly limit, with a 20% coinsurance applying to contact lenses.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Full Dual (PPO D-SNP) plan, which features no copay and a 20% coinsurance for Medicare-covered dental services, and no copay and no coinsurance for other preventive and comprehensive services up to a $1,900 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Full Dual (PPO D-SNP) with no copays, although prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no copays, though prior authorization is required. Outpatient diagnostic procedures, lab services, therapeutic radiological services, and X-rays require a 20% coinsurance, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Full Dual (PPO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers some Cardiac Rehabilitation Services with no copay, but key options like standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for symptomatic Peripheral Artery Disease (PAD) are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without requiring a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Full Dual (PPO D-SNP) are partially covered with no copay and no coinsurance, providing a $150 monthly over-the-counter allowance, chronic illness meals, and select annual screenings. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved