Aetna Medicare Dual Select Choice (PPO D-SNP)
Aetna Medicare Dual Select Choice (PPO D-SNP) H5521-463 Plan Details
Aetna Medicare Dual Select Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-463
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 Select Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-463
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) H5521-463 Plan Details
Aetna Medicare Dual Select Choice (PPO D-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-463
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
Alabama Counties Served
Noxubee
Morgan
Marshall
Winston
Franklin
Lawrence
Marion
Colbert
Dade
Limestone
Lauderdale
Madison
Jackson
De Kalb
Tallapoosa
Elmore
Chilton
Perry
Crenshaw
Autauga
Macon
Lowndes
Barbour
Pike
Coffee
Bullock
Washington
Butler
Dale
Montgomery
Henry
Houston
Covington
Wilcox
Russell
Chambers
Geneva
Escambia
Clarke
Baldwin
Mobile
Marengo
Choctaw
Dallas
Lee
Randolph
Saint Clair
Coosa
Tuscaloosa
Jefferson
Walker
Shelby
Calhoun
Cullman
Talladega
Blount
Bibb
Clay
Etowah
Lamar
Fayette
Greene
Hale
Pickens
Cherokee
Cleburne
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $7900 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 - $15 based on level of Medicaid eligibility.||Out-of-Network|$0 - $15 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: Coinsurance for Medicare Covered Chiropractic Services 0% or 20% |
| 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 Copayment for Routine Foot Care $0
Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 or $15 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-$15 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-$15 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||$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-$15 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-$15 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 |
