Aetna Medicare Dual Signature Select (HMO D-SNP)

Aetna Inc.
Aetna Medicare Dual Signature Select (HMO D-SNP) H5325-011 Plan Details
4.5 out of 5 stars

Aetna Medicare Dual Signature Select (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5325-011

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 Signature Select (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5325-011

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 Signature Select (HMO D-SNP) H5325-011 Plan Details
4.5 out of 5 stars

Aetna Medicare Dual Signature Select (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5325-011

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

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
Specialty Doctor Visit
In-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.
Urgent Care
Copayment for Urgent Care $0 or $25

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 - $290 based on level of Medicaid eligibility.

Health Care Services and Medical Supplies

Aetna Medicare Dual Signature Select (HMO 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 $10
Copayment for Routine Care $0
  • Maximum 12 Routine Care every year
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|0%
Durable Medical Eqipment (DME)
In-Network|$0 - 20% based on level of Medicaid eligibility.
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0
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
Imaging: Xray: $0|CT Scans: $0 - 20%|Diagnostic Radiology other than CT Scans: $0 - 20% based on level of Medicaid eligibility|Diagnostic Radiology Mammogram: 0%.
Home Health Care
$0
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
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
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
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
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 $15
Copayment for Routine Foot Care $0
  • Maximum 6 visits every year
Skilled Nursing Facility Care
$0 - $0 per day, days 1-20
$214 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
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|$2,500 benefit amount (allowance) every year for covered preventive and comprehensive dental services. Frequencies and medical necessity requirements vary by covered dental service.||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)||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||$440 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)|$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)

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