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Aetna Medicare Dual Extra (PPO D-SNP) - H1608-076-000
$0.00
Monthly Premium
Aetna Medicare Dual Extra (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H1608-076-000
** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
If you have Medicare in Arkansas, you may want to review your coverage options. Medicare Advantage plans cover services that aren’t covered by Original Medicare (Part A and Part B).
Aetna Medicare Advantage plans may cover prescription drugs and plans may offer other benefits that Original Medicare doesn’t cover.
Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Aetna Medicare Dual Extra (PPO D-SNP) Basic Costs and Coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Dual Extra (PPO D-SNP) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $615.00 |
| Out-of-pocket maximum | $0.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | In-Network $0 Out-of-Network $0 - 30% based on level of Medicaid eligibility |
| Specialty doctor visit | In-Network $0 Out-of-Network $0 - 30% based on level of Medicaid eligibility |
| Inpatient hospital care | In-Network $0 Out-of-Network $0 - $2230 per stay based on level of Medicaid eligibility |
| Urgent care | Urgent Care: Copayment for Urgent Care $0 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 Maximum Plan Benefit of $250,000 |
| Emergency room visit | $0 - $115 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. |
| Ambulance transportation | Out-of-Network|$0 - 20% based on level of Medicaid eligibility |
Additional Health Services and Supplies Coverage
Aetna Medicare Dual Extra (PPO D-SNP) may cover additional health services and medical supplies. Learn more below:
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0 Copayment for Routine Care $0
|
| Diabetes supplies, training, nutrition therapy and monitoring | Out-of-Network|0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies|$0 - 20% based on level of Medicaid eligibility for other covered diabetic supplies |
| Durable medical equipment (DME) | In-Network $0 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 - 50% based on level of Medicaid eligibility Diagnostic Procedures: In-Network $0 Out-of-Network $0 - 50% based on level of Medicaid eligibility Imaging: In-Network Xray: $0 CT Scans: $0 Diagnostic Radiology other than CT Scans: $0 Diagnostic Radiology Mammogram: $0 Out-of-Network $0 - 50% based on level of Medicaid eligibility |
| Home health care | Out-of-Network|$0 - $0 based on level of Medicaid eligibility |
| Mental health inpatient care | Out-of-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital per Stay $0 or $2080 |
| Mental health outpatient care | Out-of-Network|$0 - 30% for Mental Health Services- Group Sessions based on level of Medicaid eligibility|$0 - 30% for Mental Health Services - Individual Sessions based on level of Medicaid eligibility|$0 - 30% for Psychiatric Services - Group Sessions based on level of Medicaid eligibility|$0 - 30% 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: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter items | Over-the-Counter (OTC) Wallet with a $105 monthly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating locations including CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions. Qualifying members may be eligible for additional spending categories on the Extra Supports Wallet. See EOC for more information on the Extra Supports Wallet. |
| Podiatry services | Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 |
| Skilled Nursing Facility (SNF) care | Out-of-Network|$0 - $0 per day, days 1-20; $218 per day, days 21-100 based on level of Medicaid eligibility |
Dental Benefits
Aetna Medicare Dual Extra (PPO D-SNP) offers the following dental benefits and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| 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 $1,500 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services combined. ADA recognized dental services are covered up to the benefit amount excluding implants and implant related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions. |
Vision Benefits
Aetna Medicare Dual Extra (PPO D-SNP) offers the following vision benefits. There may be provider network restrictions. You can find more information about network restrictions in the Evidence of Coverage.
| Coverage | Details |
|---|---|
| Vision care | Out-of-Network||Eye Exams:|0%-40% based on level of Medicaid eligibility for Medicare-covered eye exams|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50)||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||$350 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
Aetna Medicare Dual Extra (PPO D-SNP) offers the following hearing benefits and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | 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
Aetna Medicare Dual Extra (PPO D-SNP) offers the following preventive services, benefits and wellness programs. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | In-Network $0 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 |
Prescription Drug Costs and Coverage
Aetna Medicare Dual Extra (PPO D-SNP) offers prescription drug coverage, with an annual drug deductible of $615.00 (excludes Tiers 1 and 2)
|
Coverage & Cost |
|
|---|---|
Coverage |
Cost |
Annual drug deductible |
$615.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
Annual drug deductible |
$615.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
Annual drug deductible |
$615.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
We can help you find out if your doctors are in a plan’s network when reviewing Aetna Medicare Advantage plans in Arkansas. We can also help you look for plans that cover your prescription drugs.
There may be other Aetna Medicare Advantage plans available in Arkansas. Call 1-800-891-6309 TTY 711, 24/7 to speak with a licensed TZ insurance agent* who can help you compare plans where you live.
Plan Documents
Learn more about Aetna Medicare Dual Extra (PPO D-SNP) by reviewing the following documents:
| Links to plan documents |
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