Aetna Medicare Dual Choice (PPO D-SNP)
Aetna Medicare Dual Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) 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.
Aetna Medicare Dual Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) 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.
North Carolina Counties Served
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
Initial Coverage Limit | $2000 |
Catastrophic Coverage Limit | $2,000 |
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 | 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 | In-Network: Copayment for Medicare-covered Chiropractic Services $0 Copayment for Routine Care $0
Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $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 Eqipment (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 Prior authorization required 0 or $ Out-of-Network: Psychiatric Hospital Services: $354 per day for days 1 to 8 $0 per day for days 9 to 90 |
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: 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 Prior authorization required 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: 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 |