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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 North Carolina. 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 $41.80. 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 $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 $9350.00 (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 $9350.00 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 Choice (PPO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs, which vary depending on the drug tier and pharmacy. This plan may have a reduced premium if you qualify for the low-income subsidy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's formulary should be checked for specific drugs covered.
Additional Benefits
The Aetna Medicare Dual Choice (PPO D-SNP) plan offers comprehensive coverage with varying costs. This plan includes no copay for primary care, preventive services, hearing exams, vision services, dental services, home health services, and outpatient blood services. You will pay a copay for inpatient hospital stays, outpatient services, emergency services, specialist visits, and some therapies. The plan also provides coverage for ambulance services, with no copay for ground ambulance services, and a copay for air ambulance services. Additional benefits include coverage for durable medical equipment and home infusion services, with varying coinsurance amounts. This plan also covers skilled nursing facilities, lab services, and diagnostic services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you have a $332 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, the copay is $254 for days 1-8, and no copay for days 9-90. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $332, observation services with a $332 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $50 copay. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan, including all ambulance services, ground ambulance services with a $275 copay, and air ambulance services with 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, with 12 one-way trips per year using rideshare services, bus/subway, or medical transport. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.
Primary Care See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers primary care physician services and chiropractic services with no copay, while occupational therapy services, physical therapy, and speech-language pathology services have a $25 copay. Physician specialist services have a $15 copay, and mental health specialty services have a $50 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Psychiatric services individual and group sessions have a $40 copay, and Opioid Treatment Program Services have a $50 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services with no copay for Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered up to $1250 per ear every year, with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear, are not covered; OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers vision services including eye exams and eyewear. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum benefit of $330 every year for eyewear.
Dental Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers dental services with a $2,100 maximum benefit per year, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. This plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
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 under the Aetna Medicare Dual Choice (PPO D-SNP) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 20% coinsurance, and Diabetic Equipment. 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 by the Aetna Medicare Dual Choice (PPO D-SNP) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $300, Therapeutic Radiological Services have a copay of $15, and Outpatient X-Ray Services have no copay.
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. However, 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. Despite this, the plan does mention that there is a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Dual Choice (PPO D-SNP) plan, with prior authorization required. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and numerous other services are not covered.
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