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Aetna Medicare Duly Prime (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Duly Prime (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Duly Prime (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Duly Prime (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Chicago. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Duly Prime (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Duly Prime (PPO).
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 Duly Prime (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7500.00 (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 $7500.00 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 Duly Prime (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Duly Prime (PPO) plan offers a wide range of benefits with varying costs. Many services have no copay, including primary care, preventive services, routine hearing exams, vision services like eye exams, and many dental services. The plan also offers coverage for inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $0 to $250 depending on the service. Additional benefits include coverage for hearing aids, vision eyewear, and over-the-counter items, each with specific coverage limits. The plan also covers services like home health, skilled nursing facilities, and home infusion, with some services requiring prior authorization and having associated copays or coinsurance.
Inpatient Hospital See details
The Aetna Medicare Duly Prime (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For inpatient hospital-acute, you pay a $225 copay for days 1-5, and no copay for days 6-90, and additional days are covered with no copay. Inpatient hospital psychiatric stays have the same cost structure as acute care. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $250, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and individual and group sessions for outpatient substance abuse have a copay of $75.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Duly Prime (PPO) plan, with a $65 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Duly Prime (PPO) plan. Ground Ambulance Services have a $250 copay, while Air Ambulance Services have a 20% coinsurance; 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage has a $125 copay, Worldwide Emergency Transportation has a $250 copay, and Urgently Needed Services have a $40 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $30 copay. Physician Specialist Services have a copay between $0 and $20, and Mental Health Specialty Services have a $20 copay for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20, while Psychiatric Services individual and group sessions have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75. Opioid Treatment Program Services have a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, or Support for Caregivers of Enrollees.
Hearing Services See details
Hearing exams are covered with a $20 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a plan-specified amount of $750.00 per ear. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Duly Prime (PPO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$20, while routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit of $240 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. This plan also covers orthodontic services, with a maximum benefit of $2800 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Duly Prime (PPO) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment and prosthetics, is covered by the Aetna Medicare Duly Prime (PPO) plan. Durable medical equipment has a coinsurance of 0-20%, and medical supplies have a coinsurance of 0-20%. Diabetic supplies have a coinsurance of 0-20%, and diabetic therapeutic shoes or inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services and radiological services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Duly Prime (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Duly Prime (PPO) plan, but the specific services are not covered. There is a copay for some services, but more information is needed to determine the exact cost.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Duly Prime (PPO) plan, but prior authorization is required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered are not covered.
Other Services See details
The Aetna Medicare Duly Prime (PPO) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage of $90 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other services, including a meal benefit, Other 1 (annual wellness exam and screening mammography), and Other 2 (gFOBT, FIT) are also covered with no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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