A non-government entity
Aetna Medicare Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Enhanced (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in Atlanta and Savannah. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Enhanced (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Aetna Medicare Enhanced (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Enhanced (PPO) prescription drug plan features an annual drug deductible of $615. For initial coverage, Tier 1 (Preferred Generic) and Tier 2 (Generic) medications have no copay when filled through preferred pharmacies or preferred mail order. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For brand-name and specialty drugs, you will pay a percentage of the drug cost rather than a flat copay. Tier 3 (Preferred Brand) drugs require a 24% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications both carry a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail order options.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, while specialist visits require a copay ranging from $0 to $45. For inpatient hospital stays, patients pay a $407 daily copay for the first few days, with no copay for subsequent days. Emergency room visits carry a $115 copay, which is waived if admitted, and urgent care services require a $40 copay, both featuring no coinsurance. Routine vision, hearing, and preventive physical exams are covered with no copay or coinsurance, alongside a quarterly $60 allowance for over-the-counter items. Medicare-covered dental and vision exams require a copay of up to $45, while home health services and skilled nursing facility stays for the first 20 days are available with no copay. Medical equipment and dialysis services generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) inpatient hospital benefits are partially covered with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Patients pay a $407 daily copay for days 1-6 of acute stays (no copay for days 7 and beyond) and a $407 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90).
Outpatient Services See details
Aetna Medicare Enhanced (PPO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $450, observation services require a $407 copay per stay, and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copay of either $105.00 or $110.00 and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (PPO) covers ambulance services with prior authorization, charging a $260 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Some transportation services are covered, but transportation to plan-approved locations or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Enhanced (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $260.
Primary Care See details
Primary care benefits under the Aetna Medicare Enhanced (PPO) plan feature no copay and no coinsurance for primary care visits, and a $0 to $45 copay with no coinsurance for specialists. Physical, occupational, and mental health therapies are covered with copays between $30 and $50 and no coinsurance, while podiatry is not covered and only some chiropractic services are covered, excluding routine and other chiropractic care.
Preventive Services See details
Preventive Services under the Aetna Medicare Enhanced (PPO) are partially covered, offering most services—such as annual physicals, fitness benefits, and screenings—with no copay and no coinsurance, while kidney disease education has a 20% coinsurance and no copay. However, several supplemental benefits are not covered, including medical nutrition therapy, weight management programs, alternative therapies, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (PPO), which offers Medicare-covered exams for a $45 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, though OTC, inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (PPO) with no deductibles and no coinsurance, featuring no copay for routine eye exams and eyewear. Medicare-covered eye exams have a copay of up to $45, and the plan provides a yearly maximum benefit of $50 for exams and $375 for eyewear.
Dental Services See details
Aetna Medicare Enhanced (PPO) dental services are partially covered, with no coverage for other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered services feature no copay and coinsurance ranging from no coinsurance up to 50%.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Enhanced (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Enhanced (PPO) plan, offering durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (PPO), with prior authorization required. Diagnostic tests and procedures have a $0 to $95 copay and no coinsurance, lab services and outpatient X-rays require no copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the Aetna Medicare Enhanced (PPO) plan, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Enhanced (PPO) with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced (PPO) with no copay and no coinsurance for covered benefits including a $60 quarterly over-the-counter allowance, meal benefits, and annual wellness exams, while acupuncture is not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved