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Aetna Medicare Dual Care (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual 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 Care (PPO D-SNP) in 2026, please refer to our full plan details page.
Aetna Medicare Dual 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 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 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 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 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 Care (PPO D-SNP) prescription drug plan has an annual drug deductible of $615. Under this plan, there is no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic drugs, you will pay a copay of $10 for a 1-month supply, $20 for a 2-month supply, or $30 for a 3-month supply. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The Aetna Medicare Dual Care (PPO D-SNP) plan offers robust medical coverage featuring no copay and no coinsurance for primary care provider visits and home health services. Specialist office visits require a $35 copay, while emergency care has a $115 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $388 copay for days one through seven and no copay for additional days. In addition to core medical care, this plan provides valuable everyday health benefits including dental, vision, and hearing coverage with no copay. Members receive up to a $1,000 annual limit for dental services, a $250 yearly eyewear allowance, and up to $1,250 per ear annually for prescription hearing aids. This plan also supports healthy living with a $40 monthly over-the-counter reimbursement and up to 12 one-way trips per year to approved locations with no copay.
Inpatient Hospital See details
Aetna Medicare Dual Care (PPO D-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $388 copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric care requires a $624 copay for days 1 through 3 and no copay for days 4 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Dual Care (PPO D-SNP) plan are covered, featuring no copay and no coinsurance for ambulatory surgical center and blood services. Outpatient hospital services require no coinsurance with copays ranging from $0 to $388, while outpatient substance abuse services involve a $40 copay for individual sessions and 20% coinsurance for group sessions.
Partial Hospitalization See details
Aetna Medicare Dual Care (PPO D-SNP) covers partial hospitalization benefits with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers ambulance services with a $280 copay for ground transport and a 20% coinsurance for air transport, subject to prior authorization. Transportation services are partially covered with no copay or 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
Aetna Medicare Dual Care (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 are covered with a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Primary Care benefits under Aetna Medicare Dual Care (PPO D-SNP) feature no copay and no coinsurance for primary care provider visits, while specialist visits require a $35 copay and no coinsurance. Other services such as physical therapy have a $20 copay, mental health services have a $40 copay, and chiropractic care is partially covered with a $15 copay (other chiropractic services are not covered), all with no coinsurance.
Preventive Services See details
Aetna Medicare Dual Care (PPO D-SNP) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, screenings, and select supplemental benefits, though kidney education services require a 20% coinsurance and no copay. Sub-services not covered under this plan include in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 Dual Care (PPO D-SNP) with no coinsurance or deductibles, offering routine exams and fitting evaluations for no copay, and Medicare-covered exams for a $35 copay. Prescription hearing aids are partially covered with no copay up to a $1,250 annual maximum per ear, though OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Dual Care (PPO D-SNP) with no deductibles, offering routine eye exams with no copay and a 20% coinsurance up to a $50 yearly limit. Eyewear is covered with no copay and no coinsurance up to a combined maximum benefit of $250 every year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Dual Care (PPO D-SNP), offering preventive and comprehensive care with no copay and no coinsurance up to a $1,000 annual limit for both in-network and out-of-network services. While Medicare-covered dental services require a $35 copay and no coinsurance, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B chemotherapy and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Dual Care (PPO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Care (PPO D-SNP) with no copays, though prior authorization is required. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts carry a 20% coinsurance, while diabetic supplies have no coinsurance but are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers diagnostic and radiological services, with prior authorization required for all services. Outpatient X-rays and lab services have no copay, diagnostic procedures and diagnostic radiological services require a copay with no coinsurance, and therapeutic radiological services are subject to a 20% coinsurance.
Home Health Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Dual Care (PPO D-SNP) plan with no coinsurance and a $15 copay. This copayment applies to intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (PPO D-SNP) partially 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, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Dual Care (PPO D-SNP) partially covers other services with no copay and no coinsurance, although acupuncture is not covered. Covered benefits include a $40 monthly over-the-counter reimbursement, meals for chronic illnesses, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings.
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