A non-government entity
Aetna Medicare Dual Preferred (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Dual Preferred (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 Preferred (PPO D-SNP) in 2025, please refer to our full plan details page.
Aetna Medicare Dual Preferred (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 in Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Dual Preferred (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 Preferred (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 Preferred (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 Preferred (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.50. 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:
Sign up for Aetna Medicare Dual Preferred (PPO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Dual Preferred (PPO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for your prescriptions, but the specific costs for each drug tier are not provided in this summary. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. The monthly premium for Part D is $29.50 for those with LIS. Once your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Dual Preferred (PPO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have a $2015 copay per admission, while outpatient services and many specialist visits involve 20% coinsurance. Emergency services have a copay, but worldwide emergency services have no copay or coinsurance. Preventive services, including an annual physical exam, have no copay, and the plan provides coverage for hearing, vision, and dental services with varying cost-sharing. The plan also covers home health services, diabetic supplies, and medical equipment with no copay or 20% coinsurance. Other benefits include transportation, and over-the-counter items with no copay, but some services like cardiac rehabilitation and certain home care services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each with a copay of $2015 per admission or stay. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, and outpatient substance abuse services, all with a 20% coinsurance. Outpatient blood services are also covered with a 20% coinsurance and a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Dual Preferred (PPO D-SNP) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a 20% coinsurance, while transportation services to plan-approved health-related locations have no copay and are limited to 12 one-way trips per year via rideshare, 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. For Emergency Services, there is a $110 copay, and for Urgently Needed Services, there is a $45 copay; both have no coinsurance. Worldwide Emergency Services has a maximum benefit of $50,000, and includes Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, all with no copay and no coinsurance.
Primary Care See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, 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. Primary care physician services and chiropractic services have a 20% coinsurance, while occupational therapy services and physical therapy and speech-language pathology services also have a 20% coinsurance. Physician specialist services have a 0-20% coinsurance, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Mental health specialty services, psychiatric services, and opioid treatment program services have a 20% coinsurance for individual and group sessions. Podiatry services have a 20% coinsurance for routine foot care with no copay, and other health care professional services have a 0-20% coinsurance. Routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as glaucoma screenings, diabetes self-management training, and barium enemas are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered, with a coinsurance of 20% for routine hearing exams and no deductible. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered up to $1250 per ear every year with no copay for Prescription Hearing Aids (all types), but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers vision services, including eye exams with a 20% coinsurance, and eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum of $425 per year. Routine eye exams and other eye exam services have no copay. Contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades have no copay.
Dental Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers dental services, 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, and a 20% coinsurance for Medicare dental services. Orthodontic services have a maximum coverage of $2,500 per year, while maxillofacial prosthetics, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the Aetna Medicare Dual Preferred (PPO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, and there is a 0-20% coinsurance for both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Dual Preferred (PPO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Additionally, the plan covers Diabetic Supplies with no copay, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Preferred (PPO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, and Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have no coinsurance, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Dual Preferred (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 Preferred (PPO D-SNP) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered and require prior authorization. The plan charges the Medicare-defined cost share for tier 1, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Dual Preferred (PPO D-SNP) plan's "Other Services" benefit covers over-the-counter items and meal benefits with no copay. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved