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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 South 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 $21.90. 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:
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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, but the specific costs for each tier are not available in this summary. Once your total drug costs reach $2,000, you will enter the next coverage phase. If you qualify for the low-income subsidy, your Part D premium may be reduced to $21.90. After your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for your covered Part D drugs.
Additional Benefits
The Aetna Medicare Dual Choice (PPO D-SNP) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services, including some primary care and specialist visits, have coinsurance. Emergency, urgent, and worldwide emergency services have a copay or coinsurance, with a maximum benefit for worldwide emergency services. This plan covers preventive services with no copay, and has no copay for home health services, hearing aids, and some vision and dental services. The plan also includes coverage for hearing, vision, and dental services, with specific copays or coinsurance amounts for certain services. Additionally, the plan covers skilled nursing facility stays with a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with prior authorization required. Inpatient Hospital-Acute has a copay of $2185 per stay, and Additional Days for Inpatient Hospital-Acute has no copay. Inpatient Hospital Psychiatric has a copay of $2036 per stay, and Additional Days for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered with a coinsurance that varies from 0% to 20%, depending on the specific service. Outpatient blood services are also covered with a 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under 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, while transportation services to a plan-approved health-related location have no copay, with 12 one-way trips covered per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Dual Choice (PPO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; Worldwide Emergency Services has a $250,000 maximum benefit coverage. Worldwide Emergency Coverage and Worldwide Urgent Coverage have no copay, and Worldwide Emergency Transportation has no coinsurance.
Primary Care See details
Under the Aetna Medicare Dual Choice (PPO D-SNP) plan, primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary care physician services, physician specialist services, physical therapy, and speech-language pathology services have a 20% coinsurance. Routine chiropractic care has no copay, and routine foot care has a 20% coinsurance. Additional telehealth benefits have no copay, but have a 20% coinsurance.
Preventive Services See details
Preventive services include no copay for annual physical exams, Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits or for fitting/evaluation for hearing aids. Prescription hearing aids are covered with no copay and a maximum plan benefit of $2000 per year. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a 20% coinsurance, and routine eye exams and other eye exam services have no copay. Eyewear has a 20% coinsurance, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay; there is a combined maximum plan benefit coverage amount of $200 every year for eyewear.
Dental Services See details
The Aetna Medicare Dual Choice (PPO D-SNP) plan covers Medicare Dental Services with 20% coinsurance and other dental services with a maximum benefit of $1500 per year. 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 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 under the Aetna Medicare Dual Choice (PPO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. 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, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment benefits are covered by Aetna Medicare Dual Choice (PPO D-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay. For Diagnostic Procedures/Tests, Lab Services, and Diagnostic Radiological Services, you pay at most 20% coinsurance, but the minimum coinsurance is 0%. For Therapeutic Radiological Services and Outpatient X-Ray Services, you pay at most 20% coinsurance, but the minimum coinsurance is 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac 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. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with a $0 copay, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other services include annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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