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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 Parishes in LA. 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 $25.80. 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:
Sign up for Aetna Medicare Dual Care (PPO D-SNP)
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Drug Coverage
The Aetna Medicare Dual Care (PPO D-SNP) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order. For Tier 2 generic medications, standard pharmacy and mail-order fills cost $10 for a one-month supply, $20 for a two-month supply, and $30 for a three-month supply. For higher-tier medications, costs transition to a coinsurance structure at standard pharmacies and standard mail-order services. Tier 3 preferred brand drugs carry a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs are also available with a 25% coinsurance for a one-month supply.
Additional Benefits
The Aetna Medicare Dual Care (PPO D-SNP) offers comprehensive medical coverage with a mix of copays and coinsurance depending on the service. Inpatient hospital stays require a $1,825 copay per stay, while outpatient services, primary care, and specialist visits generally feature no copay and a 20% coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgently needed care requires a $40 copay. This plan also includes valuable supplemental benefits to help manage everyday health needs. Preventive and comprehensive dental care is covered with no copay and no coinsurance up to a $2,500 annual limit, while routine hearing and vision exams feature no copay and a 20% coinsurance. Additionally, members receive home health services, up to 24 one-way transportation trips, and a $120 monthly over-the-counter allowance with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Dual Care (PPO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,825 copayment per stay and no coinsurance, requiring prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, substance abuse, and blood services, with no copay 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
Aetna Medicare Dual Care (PPO D-SNP) covers partial hospitalization services with prior authorization, requiring either no copay and a 20% coinsurance, or a $110.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Dual Care (PPO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Dual 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 lifetime maximum with no copays or coinsurance.
Primary Care See details
Aetna Medicare Dual Care (PPO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and a 20% coinsurance, while telehealth benefits are available with no copay and no coinsurance. Chiropractic care is partially covered, offering up to 12 routine visits per year with no copay and 20% coinsurance, though other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Dual Care (PPO D-SNP), offering annual physicals and select supplemental benefits with no copay and no coinsurance, while kidney disease education and other screenings carry a 20% coinsurance and no copay. Non-covered services 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 partially covered under Aetna Medicare Dual Care (PPO D-SNP), with routine exams requiring no copay and a 20% coinsurance, and fitting evaluations and prescription hearing aids covered with no copay or coinsurance up to a $500 annual limit per ear. However, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered under Aetna Medicare Dual Care (PPO D-SNP) with no deductibles, featuring routine eye exams with no copay and 20% coinsurance up to a $50 annual limit. Covered eyewear, including eyeglasses and contact lenses, has no copay—with contact lenses requiring a 20% coinsurance—up to a combined annual maximum of $250.
Dental Services See details
Aetna Medicare Dual Care (PPO D-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,500 annual limit, though 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, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Dual Care (PPO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Dual Care (PPO D-SNP) with no copay, though prior authorization is required. Members pay a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic shoes, while diabetic supplies are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Dual Care (PPO D-SNP) with prior authorization required and no copay. Covered diagnostic procedures, lab services, therapeutic radiological services, and outpatient X-rays require a 20% coinsurance, while diagnostic radiological services are offered with no coinsurance.
Home Health Services See details
Aetna Medicare Dual Care (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 are offered by Aetna Medicare Dual Care (PPO D-SNP) with no copay, but only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Dual Care (PPO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
Other Services are covered by Aetna Medicare Dual Care (PPO D-SNP) with no copay and no coinsurance, including up to 20 acupuncture treatments per year, a chronic illness meal benefit, and a $120 monthly reimbursement for over-the-counter items. Annual wellness exams and additional cancer screenings are also covered with no copay and no coinsurance, though highly integrated dual eligible SNP services are not covered.
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