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Aetna Medicare Dual Complete (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Complete (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 Complete (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Complete (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 2025.
It's important to know that Aetna Medicare Dual Complete (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 Complete (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 Complete (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 Complete (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.80. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $590.00 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 $14000.00 (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 $14000.00 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 Complete (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy, you will pay $49.80 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Dual Complete (PPO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services, including observation and blood services, have a 20% coinsurance. Emergency services have copays, and ambulance services have a 20% coinsurance, but transportation to health-related locations has no copay. Preventive services, primary care, and hearing services have no copays for many services, while vision and dental services have coinsurance and annual maximums. Home health services, skilled nursing facilities, and many other services have no copays. This plan also offers coverage for medical equipment, home infusion, and dialysis services with coinsurance, as well as other services like over-the-counter items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital-Acute, there is a $1950 copay per admission or stay, and for Inpatient Hospital Psychiatric, there is a $2000 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services also have a 20% coinsurance. Ambulatory surgical center services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a coinsurance of 20%.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Dual Complete (PPO D-SNP) with a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, while transportation services to a plan-approved health-related location have no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Aetna Medicare Dual Complete (PPO D-SNP). Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, and Chiropractic Services with 20% coinsurance, but Routine Chiropractic Care is not covered. Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Individual and Group Sessions for Mental Health and Psychiatric Services are covered with 20% coinsurance. Podiatry Services are covered, including Routine Foot Care with 20% coinsurance, and Medicare-covered services with no copay. Other Health Care Professional services have a 0-20% coinsurance, and Additional Telehealth Benefits have no copay. Opioid Treatment Program Services also have a 20% coinsurance.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with a copay. Additional services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Home and Bathroom Safety Devices and Modifications have a $0 copay. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have 20% coinsurance.
Hearing Services See details
Hearing exams are covered under the Aetna Medicare Dual Complete (PPO D-SNP) plan with a coinsurance of at most 20% for routine hearing exams, and fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) are covered with no copay and a maximum benefit of $2000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a 20% coinsurance, with routine eye exams and other eye exam services having no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, also have a 20% coinsurance, with all sub-services having no copay.
Dental Services See details
The Aetna Medicare Dual Complete (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services with a $2,000 annual maximum benefit. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but have limited visits. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, and requires authorization. Prosthetics/Medical Supplies - Non-Medicare benefit and Medicare-covered Prosthetic Devices have a 20% coinsurance with no copay, and require authorization. Diabetic supplies have no coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Complete (PPO D-SNP) plan. Diagnostic procedures, tests, and lab services have no copay and a coinsurance of at most 20%, while diagnostic radiological services have no copay and a coinsurance of at most 20% and therapeutic radiological services and outpatient X-ray services have no copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Dual Complete (PPO D-SNP) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Complete (PPO D-SNP), with a $0 copay for days 1-20, and a $200 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay, as well as annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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