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Aetna Medicare Dual Care (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual 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 Care (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual 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 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 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 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 Care (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.60. 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 $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 Dual Care (PPO D-SNP)
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Drug Coverage
The Aetna Medicare Dual Care (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic medications, you will pay no copay for one-month, two-month, or three-month fills at standard pharmacies and standard mail order. Tier 2 generic prescriptions require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These standard pharmacy and standard mail order rates help you clearly understand your out-of-pocket prescription drug costs under this plan.
Additional Benefits
The Aetna Medicare Dual Care (PPO D-SNP) offers comprehensive medical coverage with no copays and no coinsurance for primary care visits, telehealth, home health services, and annual preventive screenings. Specialist visits require a low $30 copay, while inpatient hospital stays feature daily copays for the first few days and no copays for the remainder of your stay. Outpatient hospital services and emergency care are covered with variable copays and no coinsurance, helping to keep your out-of-pocket costs predictable. This plan also provides valuable supplemental benefits, including routine dental and hearing exams, as well as routine eyewear, with no copays or coinsurance. Members can take advantage of additional perks such as up to 12 one-way transportation trips per year, acupuncture treatments, and a $50 monthly allowance for over-the-counter items with no copay. Most medical equipment, dialysis services, and Part B drugs carry up to a 20% coinsurance with no copays, ensuring you only pay a fraction of the cost for specialized care.
Inpatient Hospital See details
Aetna Medicare Dual Care (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, there is a $407 daily copay for days 1 through 6 and no copay for remaining days, while psychiatric stays require a $678 daily copay for days 1 through 3 and no copay for days 4 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Dual Care (PPO D-SNP), offering outpatient hospital services with copays ranging from $0 to $450 and no coinsurance, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services are covered with a $40 copay for individual sessions and a 20% coinsurance for group sessions, while outpatient blood services feature no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Dual Care (PPO D-SNP) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers ambulance services with a $270 copay for ground transport (coinsurance applies) and a 20% coinsurance for air transport (copay applies), with prior authorization required. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Care (PPO D-SNP) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance. Urgently needed services require a $15 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no copays or coinsurance.
Primary Care See details
Aetna Medicare Dual Care (PPO D-SNP) primary care benefits feature no copay and no coinsurance for primary care provider visits and telehealth services. Specialist visits require a $30 copay, therapy services require a $15 copay, and chiropractic services are partially covered with a $15 copay for routine care (other chiropractic services are not covered), all with no coinsurance. Mental health, psychiatric, and podiatry services have copays ranging from $30 to $40 with no coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Care (PPO D-SNP), offering no copay and no coinsurance for annual physicals, health education, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Sub-services not covered under this plan include medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, in-home safety assessments, medication reconciliation, readmission prevention, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers Medicare-covered hearing exams with a $30 copay and no coinsurance, while routine exams and fittings are covered with no copay and no coinsurance. Hearing aids are partially covered with no copay and no coinsurance up to $1,250 per ear yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Care (PPO D-SNP) with no coinsurance, featuring a $0 to $30 copay for eye exams and no copay for eyewear. The plan offers up to $50 annually for eye exams, including one routine exam, and a combined annual limit of $150 for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers partially covered dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $1,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Care (PPO D-SNP) with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance, while covered insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Care (PPO D-SNP) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Care (PPO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for procedures, while radiological services require a $35 copay for X-rays, 20% coinsurance for therapeutic services, and a copay with no coinsurance for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Care (PPO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers cardiac rehabilitation services with no coinsurance, but only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (PPO D-SNP) covers Skilled Nursing Facility (SNF) services 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, a prior 3-day inpatient hospital stay is not required for admission, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers other services with no copay and no coinsurance, including acupuncture up to 20 treatments per year, chronic illness meal benefits, and a $50 monthly over-the-counter allowance. This benefit is partially covered, as dual eligible SNPs with highly integrated services are not covered.
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