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Aetna Medicare Dual Choice (PPO D-SNP)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
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Monthly Premium
Aetna Medicare Dual Choice (PPO D-SNP) is a PPO D-SNP plan offered by Aetna Inc.
Plan ID: H5521-538
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Aetna Medicare Dual Choice (PPO D-SNP) - H5521-538 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
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Monthly Premium
North Carolina Counties Served
AlamanceAlexanderAlleghanyAnsonAsheAveryBeaufortBertieBladenBrunswickBuncombeBurkeCabarrusCaldwellCamdenCaswellCatawbaChathamCherokeeChowanClayClevelandColumbusCumberlandCurrituckDavidsonDavieDuplinDurhamEdgecombeForsythFranklinGastonGatesGrahamGranvilleGreeneGuilfordHalifaxHarnettHaywoodHendersonHertfordHokeHydeIredellJacksonJohnstonJonesLeeLenoirLincolnMaconMadisonMartinMcdowellMecklenburgMitchellMontgomeryMooreNashNorthamptonOrangePamlicoPasquotankPenderPerquimansPersonPittPolkRandolphRichmondRobesonRockinghamRowanRutherfordSampsonScotlandStanlyStokesSurrySwainTransylvaniaTyrrellUnionVanceWakeWarrenWashingtonWataugaWayneWilkesWilsonYadkinYancey
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2000 |
| Primary Care Doctor Visit | $0 in-network $0 out-of-network |
| Specialty Doctor Visit | In-Network $15 Out-of-Network $15 |
| Inpatient Hospital Care | $332 per day, days 1-8; $0 per day, days 9-90 in-network $432 per day, days 1-8; $0 per day, days 9-90 out-of-network |
| Urgent Care | Urgent Care: Copayment for Urgent Care $0 or $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 Maximum Plan Benefit of $250,000 |
| Emergency Room Visit | $110 If you are admitted to the hospital within 0 hours your cost share may be waived. |
| Ambulance Transportation | $275 in-network $275 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Dual Choice (PPO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $0 In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0 Copayment for Routine Care $0
|
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network 0% Out-of-Network 0% for OneTouch/LifeScan diabetic supplies 20% for other covered diabetic supplies |
| Durable Medical Equipment (DME) | In-Network 20% Out-of-Network 25% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network $0 Out-of-Network $40 Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $0 for services provided by your primary care physician in their office $100 for services performed by a provider other than your primary care physician Out-of-Network $100 Imaging: Xray: $0 in-network 40% out-of-network CT Scans: $0 for services provided by your primary care physician in their office in-network; $300 for services performed by a provider other than your primary care physician in-network Diagnostic Radiology other than CT Scans: $0 for services provided by your primary care physician in their office in-network; $300 for services performed by a provider other than your primary care physician in-network Diagnostic Radiology Mammogram: $0 in-network 20% out-of-network |
| Home Health Care | $0 in-network $0 out-of-network |
| Mental Health Inpatient Care | 0 or $In-Network: Psychiatric Hospital Services: $254 per day for days 1 to 8 $0 per day for days 9 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network $50 for Mental Health - Group Sessions $50 for Mental Health - Individual Sessions $40 for Psychiatric Services - Group Sessions $40 for Psychiatric Services - Individual Sessions Out-of-Network $50 for Mental Health Services- Group Sessions $50 for Mental Health Services - Individual Sessions $50 for Psychiatric Services - Group Sessions $50 for Psychiatric Services - Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $232 for all other ambulatory surgical center services Out-of-Network $332 |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 or $50 Copayment for Medicare-covered Group Sessions $0 or $50 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $0 or $50 Copayment for Medicare Covered Group Sessions $0 or $50 |
| Over-the-counter (OTC) Items | By qualifying for enrollment in this plan, members receive coverage for approved over-the-counter (OTC) products under the Extra Supports Wallet on the Extra Benefits Card. |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $0 Copayment for Routine Foot Care $0
Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 Non-Medicare Covered Podiatry Services: Copayment for Non-Medicare Covered Podiatry Services $0 |
| Skilled Nursing Facility Care | $0 per day, days 1-20; $214 per day, days 21-100 in-network $0 per day, days 1-20; $214 per day, days 21-100 out-of-network |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network Preventive dental services: $0 for oral exams $0 for cleanings $0 for fluoride treatment $0 for x-rays $0 for other diagnostic dental services $0 for other preventive dental services Comprehensive dental services: $0 for restorative services $0 for endodontic services $0 for periodontic services $0 for removeable prosthodontics $0 for fixed prosthodontics $0 for oral and maxillofacial surgery $0 for adjunctive services Out-of-Network Preventive dental services: $0 for oral exams $0 for cleanings $0 for fluoride treatments $0 for x-rays $0 for other diagnostic dental services $0 for other preventive dental services Comprehensive dental services: $0 for restorative services $0 for endodontic services $0 for periodontic services $0 for removeable prosthodontics $0 for fixed prosthodontics $0 for oral and maxillofacial surgery $0 for adjunctive services $2,100 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services. ADA recognized dental services are covered up to the benefit amount excluding implants and related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network Eye Exams: $0 for non-Medicare covered eye exams (Maximum one non-Medicare covered eye exam every year in or out-of-network) Eyewear: $0 for Contacts $0 for Eyeglasses $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Upgrades Out-of-Network Eye Exams: $0-$0 based on level of Medicaid eligibility for Medicare-covered eye exams $0 for non-Medicare covered eye exams (Maximum one non-Medicare covered eye exam every year in or out-of-network) Eyewear: 0%-40% based on level of Medicaid eligibility for Medicare-covered prescription eyewear $0 for Contacts $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Eyeglass Lenses and Frames $0 for Upgrades $330 benefit amount (allowance) every year for non-Medicare covered prescription eyewear. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network Hearing Exams: $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year in or out-of-network) $0 for fitting/evaluation for hearing aids (Maximum one hearing aid fitting/evaluation every year) Hearing Aids: $0 for hearing aids $1,250 benefit amount (allowance) per ear, every year for hearing aids (Maximum two hearing aids every year) Out-of-Network: Hearing Exams: $0-$0 based on level of Medicaid eligibility for Medicare-covered hearing exams $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year in or out-of-network Hearing Aids: You must purchase hearing aids through NationsHearing |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network $0 copay for all preventive services covered under Original Medicare Out-of-Network $0 for all preventive services covered under Original Medicare |