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Aetna Medicare Dual Extra Care (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Extra Care (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 Extra Care (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual Extra Care (PPO D-SNP) is a PPO D-SNP plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across MS. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Dual Extra Care (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 Extra Care (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 Extra Care (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 Extra Care (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.80. 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 Dual Extra Care (PPO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail order. For Tier 2 generic drugs, you will pay a copay of $10 for a one-month supply, $20 for a two-month supply, or $30 for a three-month supply. Tier 3 preferred brand drugs require a 22% coinsurance for one-, two-, or three-month supplies. Tier 4 non-preferred drugs carry a 25% coinsurance for all supply lengths, while Tier 5 specialty drugs also require a 25% coinsurance but are limited to a one-month supply. These coinsurance rates apply to prescriptions filled at standard pharmacies as well as standard mail order services.
Additional Benefits
The Aetna Medicare Dual Extra Care (PPO D-SNP) offers comprehensive coverage for essential medical needs, with inpatient hospital stays requiring a $1,960 copay per stay and outpatient services covered with no copay and a 20% coinsurance. Primary care, specialist visits, and diagnostic services generally feature no copay and a 20% coinsurance, while home health services and telehealth visits are available with no copay and no coinsurance. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgent care requires a $40 copay. This plan also includes valuable supplemental benefits, such as dental care with no copay and up to a $1,500 annual limit for select services, alongside vision and hearing benefits that feature no copays. Additionally, members benefit from a $70 monthly over-the-counter allowance and up to 12 one-way transportation trips per year with no copay and no coinsurance. Skilled nursing facility care is covered with no coinsurance, requiring no copay for the first 20 days of your stay.
Inpatient Hospital See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,960 copayment per stay, no coinsurance, and prior authorization required. This benefit is partially covered because room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) outpatient services are covered with no copay and a 20% coinsurance, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for outpatient hospital, ambulatory surgical, and substance abuse services.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Dual Extra Care (PPO D-SNP) plan, with prior authorization required. Your cost for this benefit is either a 20% coinsurance with no copay, or a $110.00 copay with no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 12 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) 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 maximum with no copays and no coinsurance.
Primary Care See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance, while telehealth benefits have no copay and no coinsurance. Chiropractic services are partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, while other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Dual Extra Care (PPO D-SNP), with annual physicals and select supplemental benefits requiring no copay and no coinsurance, while kidney education and other screenings have no copay and 20% coinsurance. Sub-services including in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Dual Extra Care (PPO D-SNP), featuring no copay and no coinsurance for fitting evaluations and prescription hearing aids, alongside annual routine exams with a 20% coinsurance and no copay. While prescription hearing aids offer a $500 maximum benefit per ear yearly, OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no deductible, no copays, and a 20% coinsurance for routine eye exams and contact lenses. The plan offers up to a $50 annual maximum for eye exams and a $150 annual combined maximum for eyewear, including eyeglasses and upgrades.
Dental Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) features partially covered dental services, which include Medicare-covered dental services with no copay and 20% coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 annual limit. Most diagnostic, preventive, and restorative services are covered, while orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers home infusion bundled services with no copay, requiring prior authorization. Associated Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Extra Care (PPO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Dual Extra Care (PPO D-SNP) with no copays, though prior authorization is required for these services. Covered items like durable medical equipment, prosthetics, medical supplies, and diabetic shoes carry a 20% coinsurance, while diabetic supplies are available with no coinsurance from specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) covers diagnostic and radiological services with no copays, requiring prior authorization for all services. Under this plan, diagnostic radiological services have no coinsurance, while diagnostic procedures, lab services, therapeutic radiological services, and outpatient x-rays require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) offers cardiac rehabilitation benefits where some services are covered with no copay, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Dual Extra Care (PPO D-SNP) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. The benefit is partially covered because prior authorization is required and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Extra Care (PPO D-SNP) partially covers other services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $70 monthly reimbursement for over-the-counter items, chronic illness meal benefits, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings.
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