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Aetna Medicare Dual Extra Care (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra Care (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 Care (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across GA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra Care (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 Care (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 Care (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 Care (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.70. 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:
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Drug Coverage
The Aetna Medicare Dual Extra Care (PPO D-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic medications require a standard pharmacy or mail-order copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher-tier prescriptions under this plan are covered via coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These predictable tier-based costs make it easier for members to budget for their monthly medication expenses.
Additional Benefits
The Aetna Medicare Dual Extra Care (PPO D-SNP) offers robust medical coverage featuring no copay for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies to these services. Inpatient hospital stays require a $1,900 copay per stay with no coinsurance, while emergency care carries a $115 copay. Additionally, home health care and diagnostic lab tests are available to members with no copay and no coinsurance. This plan also provides valuable dental, vision, and hearing benefits, featuring no copays for preventive dental care, routine eye exams, and hearing evaluations. These supplemental benefits include generous annual coverage limits, such as up to $1,750 for dental services, $1,250 for prescription hearing aids, and a $250 combined limit for eyewear. Members can also take advantage of extra wellness perks with no copay or coinsurance, including a $110 monthly reimbursement for over-the-counter items and up to 24 one-way transportation trips per year to plan-approved locations.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,900 copayment per stay and no coinsurance, subject to prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no copay, though coinsurance ranges from no coinsurance up to 20% depending on the service. Covered care includes outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with some requiring prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Dual Extra Care (PPO D-SNP) plan with prior authorization required. Depending on the service, your costs will either be a 20% coinsurance with no copay, or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance, up to a $250,000 maximum plan benefit.
Primary Care See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance (up to 20% coinsurance for other health professionals). Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered. Additional telehealth services are also available with no copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Extra Care (PPO D-SNP), offering no copay and no coinsurance for annual physicals, health education, and select fitness benefits. While kidney disease education and glaucoma screenings have no copay but require a 20% coinsurance, other sub-services like weight management, alternative therapies, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered under the Aetna Medicare Dual Extra Care (PPO D-SNP) plan, featuring one annual routine hearing exam with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to a $1,250 annual limit with no copay or coinsurance, although OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers vision services with no deductibles, offering routine eye exams and follow-up diabetic eye exams with no copay, though routine exams carry a 20% coinsurance and a $50 annual limit. Covered eyewear, including eyeglasses and upgrades, features no copay and no coinsurance, while contact lenses have no copay but require a 20% coinsurance, up to a combined annual limit of $250.
Dental Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) partially covers dental services with no copay and no coinsurance for most preventive and comprehensive services up to a $1,750 annual limit, while Medicare-covered dental services require a 20% coinsurance and no copay. Implant services, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and general drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic equipment, with no copay and prior authorization required. While diabetic supplies have no coinsurance, other covered equipment and supplies require a coinsurance ranging from 0% to 20%, with prosthetic devices and therapeutic shoes carrying a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with prior authorization required and no copays for any services. There is no coinsurance for lab services and diagnostic radiological services, while diagnostic procedures, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers Cardiac Rehabilitation Services with no copay, but while some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services under the Aetna Medicare Dual Extra Care (PPO D-SNP) are covered with no copay and no coinsurance, including up to 20 acupuncture treatments annually, chronic illness meals, and a $110 monthly over-the-counter item reimbursement. While annual wellness exams and additional screenings are covered, highly integrated dual-eligible services and some other services are not covered.
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