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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 2026, 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 2026.
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 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 $10100.00 (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 $10100.00 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) prescription drug plan features an annual drug deductible of $615. Beneficiaries can save on Tier 1 preferred generic and Tier 2 generic medications, which feature no copay when filled through preferred pharmacies or preferred mail order services. If standard pharmacies or standard mail orders are used, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For higher-tier medications, the plan transitions to coinsurance costs instead of flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy and mail order options. These cost-sharing percentages apply to all available supply durations, with Tier 5 specialty tier medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Duly Prime (PPO) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no copayments or coinsurance for primary care visits, preventive care, and home health services. Specialist visits range from no copay to a $30 copay, while acute inpatient hospital stays require a $275 daily copay for the first five days and no copay thereafter. Routine dental, vision, and hearing exams are covered with no copays, alongside allowances for prescription hearing aids and eyewear. For specialized care, diagnostic lab services and home infusion require no copay, while physical therapy and urgent care services require a $30 to $40 copay. Emergency room visits carry a $130 copay which is waived if you are admitted within 24 hours, and ground ambulance services require a $250 copay. Additionally, the plan covers critical medical equipment and dialysis services with no copay and coinsurance up to 20 percent.
Inpatient Hospital See details
Aetna Medicare Duly Prime (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $275 daily copay for days 1-5 and no copay for days 6 and beyond, while psychiatric stays cost a $225 daily copay for days 1-5 and no copay for days 6-90; non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Duly Prime (PPO) with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Duly Prime (PPO) covers partial hospitalization services with a copay of either $65.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under Aetna Medicare Duly Prime (PPO), as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $250 copay and no coinsurance, while air ambulance services carry a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Aetna Medicare Duly Prime (PPO) covers emergency services with a $130 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 services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $250.
Primary Care See details
Aetna Medicare Duly Prime (PPO) covers primary care visits with no copay and no coinsurance, and specialist services with a $0 to $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay, while mental health, psychiatric, and opioid treatment services require a $40 copay, all with no coinsurance. Telehealth benefits are available with a $0 to $40 copay and 20% coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Duly Prime (PPO) partially covers preventive services, offering annual physicals, diabetes training, and select fitness benefits with no copay and no coinsurance, while kidney disease education has no copay but a 20% coinsurance. Multiple supplemental services are not covered under this benefit, including personal emergency response systems, weight management, alternative therapies, and in-home support.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Duly Prime (PPO) with no coinsurance for all covered benefits. Medicare-covered exams require a $30 copay, while routine exams, fitting evaluations, and up to two prescription hearing aids (up to $500 per ear annually) have no copay, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Duly Prime (PPO) covers vision services with no deductibles or coinsurance, offering eye exams for a $0 to $30 copay and eyewear with no copay. The plan features a $50 annual maximum benefit for eye exams, including one routine exam yearly, and a $150 annual allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Duly Prime (PPO), with preventive care such as cleanings and exams requiring no copay and no coinsurance, while Medicare-covered dental has a $30 copay and no coinsurance. Comprehensive services are subject to no copay and 20% to 50% coinsurance up to a $2,750 yearly limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Duly Prime (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Medicare Part B chemotherapy, radiation, and clinical drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Duly Prime (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Duly Prime (PPO) covers medical equipment with no copay for durable medical equipment, prosthetics, and diabetic shoes, with coinsurance ranging from no coinsurance to 20% depending on the item. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Duly Prime (PPO) with prior authorization required. Diagnostic tests require no coinsurance and a $0 to $50 copay, lab services have no copay, and radiological services range from a $10 copay with coinsurance for X-rays to a minimum 20% coinsurance plus copay for therapeutic services.
Home Health Services See details
Aetna Medicare Duly Prime (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Duly Prime (PPO) with no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Duly Prime (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring no prior three-day inpatient hospital stay but needing prior authorization. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Aetna Medicare Duly Prime (PPO) partially covers other services, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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