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Aetna Medicare Dual Extra (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra (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 (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra (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 in 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 (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 (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 (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 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.40. 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 Extra (PPO D-SNP)
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Drug Coverage
The Aetna Medicare Dual Extra (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for one-month, two-month, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs are available with a $10 copay for a one-month supply, $20 for two months, and $30 for three months. Brand-name and specialty medications are covered under coinsurance rates rather than flat copays. Tier 3 preferred brand drugs require 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance. These coinsurance rates apply to standard pharmacy and mail order fills, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Extra (PPO D-SNP) offers comprehensive medical coverage featuring no copays for primary care, specialist visits, and outpatient services, though these typically carry a twenty percent coinsurance. Inpatient hospital stays require a two thousand seventy-five dollar copay per stay with no coinsurance, while emergency room visits carry a one hundred fifteen dollar copay that is waived upon admission. Beneficiaries can also access home health care and telehealth services with no copay and no coinsurance. For extra wellness support, the plan provides dental coverage with no copay or coinsurance up to a one thousand seven hundred fifty dollar annual limit, alongside no-copay vision and hearing benefits that include eyewear and hearing aid allowances. Members also receive twenty-four free one-way transportation trips to health-related locations each year and a one hundred five dollar monthly reimbursement for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Dual Extra (PPO D-SNP) partially covers inpatient hospital services, requiring a $2,075 copay per stay and no coinsurance for both acute and psychiatric Medicare-covered stays. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra (PPO D-SNP) offers outpatient services with no copays, though coinsurance ranges from 0% to 20% depending on the service. This coverage includes outpatient hospital visits, ambulatory surgical center services, substance abuse therapy, and outpatient blood services, with prior authorization required for most care.
Partial Hospitalization See details
Aetna Medicare Dual Extra (PPO D-SNP) covers partial hospitalization services with prior authorization, requiring either no copay and 20% coinsurance or a $110 copay and no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Extra (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 health-related locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 lifetime maximum with no copays or coinsurance.
Primary Care See details
Aetna Medicare Dual Extra (PPO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, while telehealth services feature no copay and no coinsurance. Chiropractic care is partially covered, providing routine care with no copay and 20% coinsurance for up to 12 visits per year, though other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra (PPO D-SNP), featuring annual physicals, health education, and fitness benefits with no copay and no coinsurance, alongside kidney education and select screenings that require no copay and 20% coinsurance. Excluded from coverage are in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers annual routine hearing exams with no copay and 20% coinsurance, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 limit per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers vision services with no deductible, offering eye exams and eyewear with either a 20% coinsurance or no copay. Covered benefits include one routine eye exam per year (up to a $50 maximum) and a combined $250 annual limit for contacts, eyeglasses, and upgrades.
Dental Services See details
Aetna Medicare Dual Extra (PPO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,750 annual maximum. This plan partially covers dental care, as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other covered Part B chemotherapy, radiation, and drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
The Aetna Medicare Dual Extra (PPO D-SNP) plan covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Dual Extra (PPO D-SNP) covers medical equipment with no copays, though prior authorization is required. Beneficiaries will pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with prior authorization required and no copays. Lab services and diagnostic radiological services feature no coinsurance, while diagnostic procedures, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Dual Extra (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Dual Extra (PPO D-SNP) with no copay, although key sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Extra (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Extra (PPO D-SNP) provides partially covered Other Services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits under this plan include a $105 monthly over-the-counter item reimbursement, chronic illness meal benefits, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings.
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