Aetna Medicare Dual Select Choice (PPO D-SNP)
Aetna Medicare Dual Select Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1608-077
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 Select Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1608-077
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.
Arkansas 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 - $0 based on level of Medicaid eligibility out-of-network |
Specialty Doctor Visit | In-Network|$0 - $25 based on level of Medicaid eligibility.||Out-of-Network|$0 - $25 based on level of Medicaid eligibility |
Inpatient Hospital Care | $0 - $380 per day, days 1-7; $0 per day, days 8-90 based on level of Medicaid eligibility in-network.|$0 - $380 per day, days 1-7; $0 per day, days 8-90 based on level of Medicaid eligibility out-of-network |
Urgent Care | Copayment for Urgent Care $0 or $15 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 Maximum Plan Benefit of $250,000 |
Emergency Room Visit | $0 - $110 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. |
Ambulance Transportation | $0 - $280 based on level of Medicaid eligibility in-network.|$0 - $280 based on level of Medicaid eligibility out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Dual Select 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 or $15 Copayment for Routine Care $0
Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $0 or $15 |
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 - 20% based on level of Medicaid eligibility.||Out-of-Network|$0 - 20% based on level of Medicaid eligibility |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network|$0||Out-of-Network|$0 - 40% based on level of Medicaid eligibility 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|$0 - $95 based on level of Medicaid eligibility for services performed by a provider other than your primary care physician||Out-of-Network|$0 - 20% based on level of Medicaid eligibility Imaging: Xray: $0 in-network|$0 - 40% based on level of Medicaid eligibility out-of-network|CT Scans: $0 - 20% in-network|Diagnostic Radiology other than CT Scans: $0 - 20% in-network|based on level of Medicaid eligibility|Diagnostic Radiology Mammogram: 0% in-network|$0 - 20% based on level of Medicaid eligibility out-of-network |
Home Health Care | $0 in-network||$0 - $0 based on level of Medicaid eligibility out-of-network |
Mental Health Inpatient Care | 0 or $In-Network: Psychiatric Hospital Services: $678 per day for days 1 to 3 $0 per day for days 4 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 0% or 40% |
Mental Health Outpatient Care | In-Network|$0 - $40 for Mental Health: Group Sessions|$0 - $40 for Mental Health: Individual Sessions|$0 - $40 for Psychiatric Services: Group Sessions|$0 - $40 for Psychiatric Services: Individual Sessions||based on level of Medicaid eligibility||Out-of-Network|$0 - 40% for Mental Health Services- Group Sessions based on level of Medicaid eligibility|$0 - 40% for Mental Health Services - Individual Sessions based on level of Medicaid eligibility|$0 - 40% for Psychiatric Services: Group Sessions based on level of Medicaid eligibility|$0 - 40% for Psychiatric Services: Individual Sessions based on level of Medicaid eligibility |
Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$0 - $280 for all other ambulatory surgical center services based on level of Medicaid eligibility||Out-of-Network|$0 - 20% based on level of Medicaid eligibility |
Outpatient Substance Abuse Care | In-Network: Coinsurance for Medicare-covered Individual Sessions 0% or 20% Coinsurance for Medicare-covered Group Sessions 0% or 20% 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 40% Coinsurance for Medicare Covered Group Sessions 0% or 40% |
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 or $25 Copayment for Routine Foot Care $0
Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 or $25 Non-Medicare Covered Podiatry Services: Copayment for Non-Medicare Covered Podiatry Services $0 |
Skilled Nursing Facility Care | $0 - $0 per day, days 1-20 $214 per day, days 21-100 based on level of Medicaid eligibility in-network|$0 - $0 per day, days 1-20 $214 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||$2,000 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 Diabetic eye exams|$0-$25 based on level of Medicaid eligibility for all other 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-$25 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||$300 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-$25 based on level of 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)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$500 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)||Out-of-Network:||Hearing Exams:|$0-$25 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 |