Aetna Medicare Dual Care (PPO D-SNP) Costs & Coverage, Lowndes County, Mississippi
Aetna Medicare Dual Care (PPO D-SNP) Costs & Coverage, Lowndes County, Mississippi
Explore the benefits and costs of Aetna Medicare Dual Care (PPO D-SNP), a 2026 Medicare Special Needs Plan designed to meet your unique healthcare needs. Review this plan to understand how it aligns with your health and financial goals.
This Aetna Medicare PPO D-SNP plan is required to provide all of the same benefits as Original Medicare, but out-of-pocket costs are different. Available to qualified individual living in Lowndes County, MS, Aetna Medicare Dual Care may include extra benefits not covered by Medicare Part A or Part B.
Based on CMS enrollment data, an estimated 2,205 Medicare beneficiaries are enrolled in this plan, with 209 members in Lowndes County, MS.
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. The Aetna Medicare logo is a registered trademark.[2]
Aetna Medicare Dual Care Overview
| Plan ID H5521-465-0 Overview | |
|---|---|
| Health Plan ID: | H5521-465-0 |
| Medicare Advantage Plan Type: | PPO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $23.80 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Lowndes County, MS |
| Insured By: | Aetna Medicare |
We're Here to Help You Enroll
Health Plan Cost Sharing & Benefits
Aetna Medicare Dual Care is a Preferred Provider Organization (PPO) plan. As a member of this PPO plan, you typically access care through in-network providers, but you have the flexibility to see out-of-network providers if needed. Keep in mind that visits to non-network providers may result in higher out-of-pocket costs.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 0% or 30% coinsurance |
| Specialist: | In-network: $0 or $35 copay | Out-of-network: 0% or 30% coinsurance |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | In-network: $0 copay | Out-of-network: 30% coinsurance |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | In-network: $0 copay | Out-of-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $0 or $115 copay |
| Wordwide emergency care: | $0 copay |
| Urgent care: | $0 or $15 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $0 or $388 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay | Out-of-network: | $0 or $388 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $0 or $218 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $0 or $218 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $0 or $280 copay | Out-of-network: $0 or $280 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $0 or $40 copay | Out-of-network: 0% or 30% coinsurance |
| Outpatient group therapy: | In-network: $0 or $40 copay | Out-of-network: 0% or 30% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $0 or $388 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay | Out-of-network: | $0 or $388 per day for days 1-7 | $0 per day for days 8-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0 or $20 copay | Out-of-network: 0% or 30% coinsurance |
| Occupational therapy: | In-network: $0 or $20 copay | Out-of-network: 0% or 30% coinsurance |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: 0% coinsurance | Out-of-network: 0% or 0%-20% coinsurance |
| Durable medical equipment: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Prosthetics: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: 0% or 0%-20% coinsurance | Out-of-network: 0% or 50% coinsurance |
| Lab services: | In-network: $0 or $0-$15 copay | Out-of-network: 0% or 50% coinsurance |
| Outpatient x-rays: | In-network: $0 or $0-$95 copay | Out-of-network: 0% or 50% coinsurance |
| Diagnostic tests and procedures: | In-network: 0% or 0%-20% coinsurance | Out-of-network: 0% or 50% coinsurance |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: 0% or 0%-20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0% or 0%-20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Restorative services: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: 20% coinsurance |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 0% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay |
| Upgrades: | In-network: $0 copay | Out-of-network: $0 copay |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Adult day health services: | Not covered |
| Home based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay | Out-of-network: $0 copay |
| Weight management programs: | Not covered |
| 'Wigs for chemotherapy hair loss: | In-network: $0 copay | Out-of-network: $0 copay |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | In-network: $0 copay | Out-of-network: $0 copay |
Do you have questions about the costs in this plan? Call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this Special Needs Plan (H5521-465-0) and other plans on this site.
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $23.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $23.80 |
| Low Income Premium Subsidy: | $23.84 |
| Low Income Premium Subsidy CMS Pays: | $23.80 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Aetna Medicare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Aetna Medicare Dual Care has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $10.00 copay | Coming soon |
| Preferred Brand | 22% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage PPO D-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Aetna Medicare plan.
CMS Star Ratings for Plan H5521-465-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify for Enrollment in Aetna Medicare Dual Care
To enroll in Aetna Medicare Dual Care you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
SNP Plan Enrollment Periods
Once you’ve confirmed your eligibility for Aetna Medicare Dual Care, it’s crucial to enroll during the appropriate Medicare Enrollment Period to ensure you receive the coverage you need without delay. Depending on your situation, you may need to enroll during one of the following periods:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Contact Aetna Medicare
Call 833-748-3201 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Fri 5am-6pm, Sat 6am-5pm PST) and learn more about this plan and other plans on this site. You may also Enroll Online.
| Contact Type | Details |
|---|---|
| Website: | Aetna Medicare Plan Page |
| New Members: | 1-833-859-6031 |
| Existing Members: | 1-866-409-1221 |
| Plan Address: | PO Box 7405 | London, KY 40742 |
If you qualify for Medicare benefits but have not yet enrolled or verified your status, visit Social Security Administration website or Medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 15, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Aetna Medicare, http://www.aetnamedicare.com — Last accessed October 13, 2025
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)" — Last accessed September 20, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- Medicare.gov, "Joining a plan" — Last accessed 5 May, 2025
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Page content managed by David Bynon, Medicare Analyst.