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Aetna Medicare Full Dual (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.
$0.00
Monthly Premium
Aetna Medicare Full Dual (PPO D-SNP) is a PPO D-SNP plan offered by Aetna Inc.
Plan ID: H5521-398
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 Full Dual (PPO D-SNP) - H5521-398 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$0.00
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $0 Out-of-Network: 0 |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | In-Network|$0 |
| Specialty Doctor Visit | In-Network|$0 |
| Inpatient Hospital Care | In-Network|$0 |
| Urgent Care | Urgent Care: Copayment for Urgent Care $0 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 Maximum Plan Benefit of $250,000 |
| Emergency Room Visit | $0 - $115 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. |
| Ambulance Transportation | In-Network|$0 |
Health Care Services and Medical Supplies
Aetna Medicare Full Dual (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: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 0% or 30% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0 |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | Out-of-Network|0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies|$0 - 20% based on level of Medicaid eligibility for other covered diabetic supplies |
| Durable Medical Equipment (DME) | In-Network|$0 |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network|$0 Diagnostic Procedures: In-Network|$0 Imaging: In-Network|Xray: $0|CT Scans: $0|Diagnostic Radiology other than CT Scans: $0|Diagnostic Radiology Mammogram: $0 |
| Home Health Care | Out-of-Network|$0 - 0% based on level of Medicaid eligibility |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | Out-of-Network|$0 - 30% for Mental Health Services- Group Sessions based on level of Medicaid eligibility|$0 - 30% for Mental Health Services - Individual Sessions based on level of Medicaid eligibility|$0 - 30% for Psychiatric Services - Group Sessions based on level of Medicaid eligibility|$0 - 30% for Psychiatric Services - Individual Sessions based on level of Medicaid eligibility |
| Outpatient Services / Surgery | Ambulatory Surgical Center: Out-of-Network|$0 - 30% based on level of Medicaid eligibility |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 0% or 30% Coinsurance for Medicare Covered Group Sessions 0% or 30% |
| Over-the-counter (OTC) Items | Over-the-Counter (OTC) Wallet with a $130 monthly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating locations including CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions.||Qualifying members may be eligible for additional spending categories on the Extra Supports Wallet. See EOC for more information on the Extra Supports Wallet. |
| Podiatry Services | Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 0% or 30% In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $0 Copayment for Routine Foot Care $0
|
| Skilled Nursing Facility Care | Out-of-Network|$0 - $0 per day, days 1-20; $218 per day, days 21-100 based on level of Medicaid eligibility |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | 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||$3,000 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services combined. Frequencies and medical necessity requirements vary by covered dental service.||ADA recognized dental services are covered up to the benefit amount excluding implants and implant 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 | Out-of-Network||Eye Exams:|0%-30% based on level of Medicaid eligibility for Medicare-covered eye exams|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50)||Eyewear:|0%-30% 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||$250 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | Out-of-Network:||Hearing Exams:|0%-30% 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 | Out-of-Network|$0 based on level of Medicaid eligibility for all preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Full Dual (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $615 (excludes Tiers 1) |
| Preferred Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1) |
| Preferred Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1) |
| Preferred Generic |
|