Aetna Medicare Dual Care (PPO D-SNP)

Available to residents of Crawford County, GA for 2026. Contract H2293, plan 004, segment 0.

Consolidated into another plan for 2026. CMS crosswalks 2025’s Aetna Medicare Dual Signature Select (PPO D-SNP) (H2293-003-0) into this plan, so its members move here unless they choose otherwise.

Plan details

Monthly premium (Part C + D)	$14.60
— medical (Part C) part	$0.00
— drug (Part D) part	$14.60?
Monthly premium with full Extra Help (LIS)	$0.00?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,250.00?
In- and out-of-network out-of-pocket maximum	$13,900.00
Drug deductible	$615.00Tier 1 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO D-SNP?
Special needs plan	Dual-eligible SNP
Contract / plan	H2293-004-0
Offered by	Aetna Medicare
Parent organization	CVS Health Corporation
Formulary drugs	3,715
Formulary exception tier	4?
Pharmacy search	www.aetnamedicare.com/findpharmacy
Member services	(833)859-6031TTY 711

CMS star ratings

Overall: 4 out of 5 stars for Overall
Health plan (Part C): 4 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 4 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H2293 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	30% coinsurance
Specialist	$30 copay	30% coinsurance
Other health care professional	$0–$30 copay	0%–50% coinsurance
Additional telehealth services	$0 copay(authorization required)	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay
Annual physical exam	$0 copay	$0 copay
Kidney disease education	20% coinsurance	50% coinsurance
Glaucoma screening	$0 copay	20% coinsurance
Diabetes self-management training	$0 copay	20% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$95 copay(authorization required)	50% coinsurance
Lab services	$0 copay(authorization required)	50% coinsurance
Diagnostic radiology (e.g. MRI, CT)	0%–20% coinsurance(authorization required)	50% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	20% coinsurance
Outpatient x-rays	$35 copay(authorization required)	50% coinsurance
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$15 copay	—
Worldwide emergency coverage	$0 copay · $250,000 plan limit	—
Worldwide urgent care	$0 copay · $250,000 plan limit	—
Worldwide emergency transportation	$0 copay	—
Hospital care
Inpatient hospital stay	$407 per day for days 1–6; $0 per day for days 7–90(authorization required)	$407 per day for days 1–6; $0 per day for days 7–90
Outpatient hospital services	$0–$450 copay(authorization required)	50% coinsurance
Outpatient observation	$407 copay(authorization required)	50% coinsurance
Ambulatory surgical center	$0–$350 copay(authorization required)	50% coinsurance
Outpatient blood services	$0 copay	50% coinsurance
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $218 per day for days 21–100(authorization required)	$0 per day for days 1–20; $218 per day for days 21–100
Home health care	$0 copay(authorization required)	$0 copay
Kidney dialysis	20% coinsurance(authorization required)	20% coinsurance
Rehabilitation
Occupational therapy	$15 copay	30% coinsurance
Physical therapy and speech-language therapy	$15 copay	30% coinsurance
Cardiac rehabilitation	$15 copay	30% coinsurance
Pulmonary rehabilitation	$15 copay	30% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$678 per day for days 1–3; $0 per day for days 4–90(authorization required)	$678 per day for days 1–3; $0 per day for days 4–90
Outpatient mental health, individual session	$40 copay(authorization required)	30% coinsurance
Outpatient mental health, group session	$40 copay(authorization required)	30% coinsurance
Psychiatrist, individual session	$40 copay(authorization required)	30% coinsurance
Psychiatrist, group session	$40 copay(authorization required)	30% coinsurance
Partial hospitalization	$105 copay(authorization required)	30% coinsurance
Intensive outpatient program	$110 copay(authorization required)	30% coinsurance
Outpatient substance use, individual session	$40 copay(authorization required)	30% coinsurance
Outpatient substance use, group session	20% coinsurance(authorization required)	30% coinsurance
Opioid treatment program	$40 copay(authorization required)	50% coinsurance
Ambulance and transportation
Ground ambulance	$270 copay(authorization required)	$270 copay
Air ambulance	20% coinsurance(authorization required)	20% coinsurance
Transportation to plan-approved locations	$0 copay(limits apply)	$0 copay
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	20% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	20% coinsurance
Medical supplies	20% coinsurance(authorization required)	20% coinsurance
Diabetes supplies	0% coinsurance(authorization required)	0%–20% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay	30% coinsurance
Routine chiropractic care	$0 copay(limits apply)	30% coinsurance
Acupuncture	$0 copay(limits apply)	50% coinsurance
Foot exams and treatment (Medicare-covered)	$30 copay	50% coinsurance
Routine foot care	$30 copay(limits apply)	50% coinsurance
Dental?
Medicare-covered dental services	$30 copay(authorization required)	$15 copay
Preventive dental plan limit	$1,000 plan limit every year	—
Oral exams	$0 copay	20% coinsurance
Cleanings	$0 copay	20% coinsurance
Fluoride treatment	$0 copay	20% coinsurance
Dental x-rays	$0 copay	20% coinsurance
Other diagnostic dental services	$0 copay	20% coinsurance
Other preventive dental services	$0 copay	20% coinsurance
Restorative services (fillings, crowns)	$0 copay	20% coinsurance
Endodontics (root canals)	$0 copay	20% coinsurance
Periodontics (gum disease)	$0 copay	20% coinsurance
Dentures and other removable prosthodontics	$0 copay	20% coinsurance
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	$0 copay	20% coinsurance
Oral and maxillofacial surgery	$0 copay	20% coinsurance
Orthodontics	Not covered	—
Adjunctive general services	$0 copay	20% coinsurance
Vision?
Eye exam (Medicare-covered)	$0–$30 copay(limits apply)	50% coinsurance
Routine eye exam	$0 copay(limits apply)	$0 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	50% coinsurance
Eyewear plan limit	$150 plan limit every year	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	$0 copay(limits apply)	$0 copay
Eyeglass lenses	$0 copay(limits apply)	$0 copay
Eyeglass frames	$0 copay(limits apply)	$0 copay
Eyewear upgrades	$0 copay(limits apply)	$0 copay
Hearing?
Hearing exam (Medicare-covered)	$30 copay	50% coinsurance
Routine hearing exam	$0 copay(limits apply)	0% coinsurance
Hearing aid fitting and evaluation	$0 copay(limits apply)	$0 copay
Hearing aid plan limit	$1,250 plan limit every year	—
Hearing aids (all types)	$0 copay(limits apply)	$0 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)	$35 copay
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	20% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	20% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	$50 allowance every month	—
Meals after a hospital stay or for a chronic condition	$0 copay	$0 copay
Fitness benefit	$0 copay(limits apply)	$0 copay
Health education	$0 copay(limits apply)	$0 copay
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	$0 copay(limits apply)	$0 copay
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	$0 copay(limits apply)	$0 copay
Home and bathroom safety devices	$0 copay(limits apply)	$0 copay
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	$0 copay(limits apply)	$0 copay
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	$0 copay(limits apply)	$0 copay
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$10.00
Tier 3	22%
Tier 4	25%
Tier 5	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$10.00	$10.00	$10.00	$30.00	$30.00	$30.00
Tier 3: Preferred Brand	22%	22%	22%	22%	22%	22%
Tier 4: Non-Preferred Drug	25%	25%	25%	25%	25%	25%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Also available in 52 other GA counties

Benefits in plain text

Aetna Medicare Dual Care (PPO D-SNP) (H2293-004-0) is a 2026 PPO D-SNP Medicare Advantage plan offered by Aetna Medicare, available to residents of Crawford County, GA.

The monthly premium is $14.60 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.

Its in-network out-of-pocket maximum is $9,250.00.

The combined in- and out-of-network out-of-pocket maximum is $13,900.00.

The drug deductible is $615.00. Tier 1 exempt.

It is a special needs plan (Dual-eligible SNP).

The plan's formulary lists 3,715 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $10.00; tier 3: 22%; tier 4: 25%; tier 5: 25%.

CMS gives the plan's contract (H2293) an overall rating of 4 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.