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Aetna Medicare Full Dual (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Full Dual (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 Full Dual (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Full Dual (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Utah. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Full Dual (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 Full Dual (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 Full Dual (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 Full Dual (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.40. 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:
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Drug Coverage
The Aetna Medicare Full Dual (PPO D-SNP) prescription drug coverage includes an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a one-, two-, or three-month supply at standard pharmacies and standard mail order services. Tier 2 generic medications require a copay of $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier prescriptions, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs have a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These standard pharmacy and mail-order rates help you easily project your monthly medication expenses under this Aetna Medicare plan.
Additional Benefits
The Aetna Medicare Full Dual (PPO D-SNP) plan offers comprehensive coverage with many services requiring no copay, though certain options carry coinsurance or specific copayments. For inpatient hospital stays, members pay a $2,050 copay per stay with no coinsurance, while outpatient services and primary care visits generally feature no copay and a 20% coinsurance. Emergency care requires a $115 copay, which is waived upon admission, and urgent care has a $40 copay. Many supplemental benefits are covered with no deductible, including routine dental care up to a $3,000 annual limit and routine vision and hearing exams featuring no copay and a 20% coinsurance. Additionally, members benefit from no copay or coinsurance for home health services and up to 36 one-way transportation trips per year. Other valuable perks include a $130 monthly reimbursement for over-the-counter items and no copay for the first 20 days of skilled nursing facility care.
Inpatient Hospital See details
Inpatient Hospital benefits under the Aetna Medicare Full Dual (PPO D-SNP) are partially covered, requiring a $2,050 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional days are covered at no copayment for acute care, additional days for psychiatric stays, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers outpatient services—including outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services—with no copayments and a 20% coinsurance. Prior authorization is required for most of these outpatient services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Full Dual (PPO D-SNP) plan, requiring prior authorization. Depending on the service, you will pay either a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered with no copay or coinsurance. Up to 36 one-way trips per year to plan-approved health-related locations are covered, but transportation to any health-related location is not covered.
Emergency Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no copays or coinsurance.
Primary Care See details
Aetna Medicare Full Dual (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth benefits feature no copay and no coinsurance. Chiropractic services are partially covered under this plan, as routine chiropractic care is not covered.
Preventive Services See details
Aetna Medicare Full Dual (PPO D-SNP) provides partially covered preventive services, offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney education and other screenings have no copay and 20% coinsurance. Sub-services not covered include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission 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
Hearing services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no deductible, featuring annual routine exams for no copay and 20% coinsurance, and fitting evaluations for no copay. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no deductibles, offering annual routine eye exams and eyewear with no copay but a 20% coinsurance on routine exams and contact lenses. The plan features a $50 annual maximum for eye exams and a $250 annual maximum for eyewear services.
Dental Services See details
Aetna Medicare Full Dual (PPO D-SNP) provides partially covered dental services with no copay and no coinsurance for preventive and most comprehensive care up to a $3,000 annual limit, though Medicare-covered dental requires a 20% coinsurance and no copay. Implant services, maxillofacial prosthetics, and orthodontics are not covered by this plan.
Home Infusion bundled Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Full Dual (PPO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Full Dual (PPO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers diagnostic and radiological services with prior authorization required and no copayments. There is a 20% coinsurance for diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays, while diagnostic radiological services have no coinsurance.
Home Health Services See details
Aetna Medicare Full Dual (PPO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Aetna Medicare Full Dual (PPO D-SNP) plan feature no copay, but only some services are covered in practice as intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Full Dual (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Full Dual (PPO D-SNP) with no copay and no coinsurance, although acupuncture is not covered. Covered benefits under this plan include a $130 monthly reimbursement for over-the-counter items, meals for chronic illness, annual wellness exams and screening mammography, and additional gFOBT and FIT screenings.
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