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Aetna Medicare Dual Choice (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Choice (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 Choice (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Choice (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in MS - Statewide. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Choice (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 Choice (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 Choice (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 Choice (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.30. 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 $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:
Sign up for Aetna Medicare Dual Choice (PPO D-SNP)
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Drug Coverage
The Aetna Medicare Dual Choice (PPO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000. Once you reach $2000 in total drug costs, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Aetna Medicare Dual Choice (PPO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $1,685 copay per admission, while outpatient, partial hospitalization, and ambulance services generally have 20% coinsurance. Emergency services have a $110 copay, and primary care and specialist visits have a coinsurance of 10-20%. Preventive services, hearing and vision exams, and dental services have no copay, and the plan offers additional benefits like OTC items with no copay and a $165 monthly maximum. The plan also covers home health services with no copay and no coinsurance, but cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. For Inpatient Hospital-Acute, there is a copay of $1,685 per admission or stay; additional days are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and for Inpatient Hospital Psychiatric, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered, including 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 have a 20% coinsurance, and the plan waives the deductible for three pints of blood. Individual and group sessions for outpatient substance abuse, as well as ambulatory surgical center services, also have a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to plan-approved health-related locations have no copay and are limited to 36 one-way trips per year.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Dual Choice (PPO D-SNP) plan, with a $110 copay, and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Services are covered with no copay or coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits with the Aetna Medicare Dual Choice (PPO D-SNP) plan include coverage for primary care physician services with a 10% coinsurance, chiropractic services with a 20% coinsurance (routine care has no copay), occupational therapy services with a 20% coinsurance, physician specialist services with a 20% coinsurance, mental health specialty services with a 20% coinsurance for individual and group sessions, podiatry services with a 20% coinsurance (routine foot care) and no copay (Medicare-covered services), other health care professional with a coinsurance between 0% and 20%, psychiatric services with a 20% coinsurance for individual and group sessions, physical therapy and speech-language pathology services with a 20% coinsurance, additional telehealth benefits with no copay, and opioid treatment program services with a 20% coinsurance.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services including health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices and modifications. Other services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered. Kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and a $0 copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a $0 copay.
Vision Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers vision services, including eye exams with 20% coinsurance for routine eye exams and no copay. Eyewear, including contact lenses, eyeglasses, and upgrades, is covered with a $500 maximum plan benefit per year, and a 20% coinsurance for contact lenses and no copay.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services, and a $3,000 annual maximum for other dental services. Oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no coinsurance, 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 Choice (PPO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a coinsurance of 0%, Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) 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 not covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and cost sharing applies, but the specific copay and coinsurance amounts are not provided.
Other Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $165.00 per month. Other services, including acupuncture, are not covered.
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