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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 Oklahoma. This plan received an overall rating of 3.5 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 $28.20. 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 $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 Care (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail order costs are $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. Higher tier medications are subject to coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance for standard pharmacy and mail order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty tier coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (PPO D-SNP) plan offers robust medical coverage with no copay and no coinsurance for primary care, telehealth, and home health services. Emergency room visits carry a $115 copay, while inpatient hospital stays require a copayment of $2,230 per stay for acute care and $2,080 for psychiatric care with no coinsurance. Most outpatient hospital services, diagnostic tests, and specialist visits feature no copay but are subject to a 20% coinsurance. This plan also includes valuable everyday benefits, such as routine dental care and prescription hearing aids covered up to a $2,000 annual maximum with no copay or coinsurance. Vision care has no deductible, offering routine exams and eyewear with no copay and a 20% coinsurance up to select annual limits. Additionally, members can take advantage of a $135 monthly over-the-counter allowance, chronic illness meals, and up to 48 one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (PPO D-SNP) inpatient hospital services are partially covered with no coinsurance, requiring a $2,230 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers outpatient services with no copay, although a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for most of these services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Dual Care (PPO D-SNP) covers partial hospitalization services with prior authorization, costing either a 20% coinsurance with no copay or a $110 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 48 one-way trips per year to plan-approved locations via rideshare, public transit, or medical transport, though trips to any health-related location are not covered.
Emergency Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no copays and no coinsurance, up to a maximum benefit limit of $250,000.
Primary Care See details
Aetna Medicare Dual Care (PPO D-SNP) covers primary care physician services and telehealth benefits with no copay and no coinsurance. Other services, including specialist visits, physical therapy, psychiatric care, and podiatry, feature no copay and a 20% to 21% coinsurance, though chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers partially covered preventive services with no copay and no coinsurance for annual physicals, fitness benefits, and health education, while kidney education and specific screenings carry a 20% coinsurance and no copay. Sub-services not covered under this plan include weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, counseling, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, enhanced disease management, and telemonitoring.
Hearing Services See details
Hearing services covered by Aetna Medicare Dual Care (PPO D-SNP) include routine hearing exams with a 20% coinsurance and no copay, and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered up to a $2,000 annual maximum with no copay or coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered under the Aetna Medicare Dual Care (PPO D-SNP) plan with no deductible, offering routine and diabetic eye exams with no copay and a 20% coinsurance on routine exams up to a $50 annual limit. Covered eyewear, including eyeglasses and contact lenses, features no copay and a 20% coinsurance on contact lenses, up to a combined annual maximum of $325.
Dental Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers partially covered dental services, featuring no copay and 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 annual maximum. Fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance ranging from 0% to 20%.
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. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Dual Care (PPO D-SNP) covers durable medical equipment (DME), prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance, while diabetic therapeutic shoes and inserts carry a 20% coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. There is no coinsurance for diagnostic radiological services, while outpatient diagnostic procedures, lab services, 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 Care (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Dual Care (PPO D-SNP) with no copay, though only some services are covered as 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
Aetna Medicare Dual Care (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers partially covered other services with no copay and no coinsurance, including chronic illness meals, select preventive wellness screenings, and a $135 monthly over-the-counter allowance. Acupuncture is not covered under this plan benefit.
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