A non-government entity
Aetna Medicare Enhanced Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Extra (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 Extra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Extra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Iowa. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced Extra (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 Extra (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 Extra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.00. 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 $10000.00 (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 $10000.00 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 Extra (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 Extra (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs have a copay starting at $2, while Tier 2 drugs start at a $12 copay for a one-month supply. For higher-tier medications, cost-sharing transitions to coinsurance under this plan. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy types. These coinsurance rates apply regardless of whether you use preferred or standard pharmacies, or mail-order options.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers comprehensive medical coverage with highly competitive out-of-pocket costs, including no copay and no coinsurance for primary care doctor visits and routine preventive care. For specialized treatment, members pay a $35 copay for specialist visits, a $130 copay for emergency room care, and a $325 copay for the first five days of acute inpatient hospital stays. Outpatient services are also highly accessible, with no coinsurance and options for no copay on ambulatory surgical services. Beyond essential medical care, this plan provides valuable supplemental benefits for dental, vision, and hearing health with generous allowances and no copays or deductibles for routine exams. Vision benefits include a $250 annual eyewear allowance, while hearing coverage offers up to a $1,250 annual allowance per ear for prescription hearing aids. Dental care is covered up to a $1,500 annual maximum with no copay for non-Medicare preventive services, and members also receive a $50 quarterly over-the-counter reimbursement.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance, requiring prior authorization, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For Medicare-covered acute stays, there is a $325 copay for days 1 to 5 and no copay for day 6 and beyond, while psychiatric stays require a $370 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
Aetna Medicare Enhanced Extra (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay of $0 to $325, observation services require a $325 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization services with copays of either $55.00 or $145.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers ambulance services with prior authorization, requiring a $245 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered under this plan.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) covers emergency services with a $130 copay—waived if admitted to the hospital within 24 hours—and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays of $130 for medical care and $245 for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist, physical, occupational, and speech therapy visits with a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance, while telehealth services have a $0 to $50 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Enhanced Extra (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, screenings, and health education, while kidney disease education has no copay and a 20% coinsurance. Several supplemental services are not covered under this benefit, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay, no coinsurance, and no deductible for routine exams and fitting evaluations. Prescription hearing aids are also covered with no copay and no coinsurance up to a maximum of $1,250 per ear every year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by the Aetna Medicare Enhanced Extra (PPO) with no copay, no coinsurance, and no deductible for both in-network and out-of-network eye exams and eyewear. The plan covers one routine eye exam per year up to a $50 maximum and provides a $250 combined annual allowance for eyewear, including contacts, lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Enhanced Extra (PPO) provides partially covered dental services up to a $1,500 annual maximum for both in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered dental services feature no copay and no coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced Extra (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Enhanced Extra (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Aetna Medicare Enhanced Extra (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $20 copay for diagnostic procedures. Radiological services require a $10 copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced Extra (PPO) covers cardiac rehabilitation services with no coinsurance, though copays apply to specific treatments. There is a $20 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $50 quarterly over-the-counter reimbursement, meal benefits for chronic illnesses, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings.
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