Aetna Medicare Dual Preferred (PPO D-SNP)

Aetna Inc.
Aetna Medicare Dual Preferred (PPO D-SNP) H5521-398 Plan Details
4.5 out of 5 stars

Aetna Medicare Dual Preferred (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) 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.

$0.00
Monthly Premium

Aetna Medicare Dual Preferred (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) 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.

Aetna Inc.
Aetna Medicare Dual Preferred (PPO D-SNP) H5521-398 Plan Details
4.5 out of 5 stars

Aetna Medicare Dual Preferred (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) 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.

$0.00
Monthly Premium

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 - 50% based on level of Medicaid eligibility out-of-network
Specialty Doctor Visit
In-Network|$0||Out-of-Network|$0 - 50% based on level of Medicaid eligibility
Inpatient Hospital Care
$0 in-network|$0 - 50% per stay based on level of Medicaid eligibility out-of-network
Urgent Care
Copayment for Urgent Care $0

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0
Emergency Room Visit
$0 - $110 based on level of Medicaid eligibility. If you are admitted to the hospital within 0 hours your cost share may be waived.
Ambulance Transportation
$0 in-network|$0 - 20% based on level of Medicaid eligibility out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Dual Preferred (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
Out-of-Network:

Medicare Covered Chiropractic Services:
Coinsurance for Medicare Covered Chiropractic Services 0% or 50%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|$0||Out-of-Network|0% for OneTouch/LifeScan diabetic supplies|$0 - 20% based on level of Medicaid eligibility for other covered diabetic supplies
Durable Medical Eqipment (DME)
In-Network|$0||Out-of-Network|$0 - 50% based on level of Medicaid eligibility
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0||Out-of-Network|$0 - 50% based on level of Medicaid eligibility
Diagnostic Procedures: In-Network|$0||Out-of-Network|$0 - 50% based on level of Medicaid eligibility
Imaging: Xray: $0 in-network|CT Scans: $0 in-network|Diagnostic Radiology other than CT Scans: $0 in-network|Diagnostic Radiology Mammogram: $0 in-network|$0 - 50% based on level of Medicaid eligibility out-of-network
Home Health Care
$0 in-network|$0 - 50% based on level of Medicaid eligibility out-of-network
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $0
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:

Psychiatric Hospital Services:
Coinsurance for Psychiatric Hospital per Stay 0% or 50%
Mental Health Outpatient Care
In-Network|$0 for Mental Health:
Group Sessions|$0 for Mental Health:
Individual Sessions|$0 for Psychiatric Services:
Group Sessions|$0 for Psychiatric Services:
Individual Sessions||Out-of-Network|$0 - 50% for Mental Health Services- Group Sessions based on level of Medicaid eligibility|$0 - 50% for Mental Health Services - Individual Sessions based on level of Medicaid eligibility|$0 - 50% for Psychiatric Services:
Group Sessions based on level of Medicaid eligibility|$0 - 50% for Psychiatric Services:
Individual Sessions based on level of Medicaid eligibility
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0||Out-of-Network|$0 - 50% based on level of Medicaid eligibility
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual Sessions 0% or 50%
Coinsurance 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
  • Maximum 12 visits every year
Out-of-Network:

Medicare Covered Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 0% or 50%

Non-Medicare Covered Podiatry Services:
Coinsurance for Non-Medicare Covered Podiatry Services 0% or 50%
Skilled Nursing Facility Care
$0 in-network|$0 - $0 per day, days 1-20
$204 per day, days 21-100 based on level of Medicaid eligibility 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:|20% for oral exams|20% for cleanings|20% for fluoride treatments|20% for x-rays|20% for other diagnostic dental services|20% for other preventive dental services||Comprehensive dental services:|20% for restorative services|20% for endodontic services|20% for periodontic services|20% for removeable prosthodontics|20% for fixed prosthodontics|20% for oral and maxillofacial surgery|20% for adjunctive services||$3,000 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 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% for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||Out-of-Network||Eye Exams:|0%-50% 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%-50% 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 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 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)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$1,000 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)||Out-of-Network:||Hearing Exams:|0%-50% 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 based on level of Medicaid eligibility for all preventive services covered under Original Medicare