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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 Nebraska. 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 $52.00. 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:
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Drug Coverage
The Aetna Medicare Enhanced Extra (PPO) plan features an annual prescription drug deductible of $615. For generic medications, members can save money by using preferred pharmacies or preferred mail-order services, which offer no copay for both Tier 1 preferred generics and Tier 2 generics. If you choose standard pharmacies or standard mail-order services, Tier 1 drugs carry a $2 copay and Tier 2 drugs carry a $12 copay for a one-month supply. For higher-tier medications, cost-sharing transitions from flat copays to coinsurance percentages. Tier 3 preferred brand-name drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail-order options. Specialty medications are limited to a one-month supply, whereas other tiers offer flexible multi-month supply options.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers robust coverage with no copay for primary care visits, home health services, and preventive care like fitness benefits and annual exams. Specialist visits, physical therapy, and Medicare-covered dental services require a $35 copay, while inpatient hospital stays feature a daily copay of $325 for the first five days of acute care. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care is available for a $50 copay. For extra benefits, the plan provides generous coverage with no copay for routine dental, vision, and hearing exams, featuring a $2,000 dental benefit, a $250 annual eyewear allowance, and up to $1,250 per ear for hearing aids. Members also benefit from a $50 quarterly over-the-counter allowance and no copay for routine diagnostic lab tests. While many services require no coinsurance, specialized treatments like dialysis, chemotherapy, and durable medical equipment may require up to a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance, though prior authorization is required. Acute stays require a $325 daily copay for days 1-5 and no copay for additional days, while psychiatric stays require a $370 daily copay for days 1-5 and no copay for days 6-90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Enhanced Extra (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require prior authorization with copays ranging from $0 to $325, while outpatient substance abuse sessions require prior authorization and have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization benefits with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
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 and no copay for air transport. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered with no coinsurance, featuring a $130 copay for medical services and a $245 copay for emergency transportation, up to a $250,000 maximum benefit.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and physical therapy require a $35 copay and no coinsurance. Mental health and psychiatric services have a $40 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance for annual exams, fitness benefits, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Enhanced Extra (PPO) covers hearing services with no copay and no coinsurance, including annual routine exams, fitting evaluations, and up to two prescription hearing aids with a $1,250 maximum benefit per ear. However, these services are only partially covered, as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered under the Aetna Medicare Enhanced Extra (PPO) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. Members receive one routine eye exam per year with a $50 maximum benefit and a combined $250 annual allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Enhanced Extra (PPO), featuring a $2,000 maximum annual benefit for both in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, excluding orthodontics, implants, and maxillofacial prosthetics which are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay, requiring prior authorization. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy and other drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Enhanced Extra (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
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 up to 20%. Prior authorization is required for these covered services, and diabetic supplies may be limited to specific manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (PPO) covers diagnostic and radiological services, offering diagnostic lab services with no copay or coinsurance, and diagnostic tests with copays ranging from no copay up to $20. Radiological services, which require prior authorization, include outpatient X-rays for a $10 copay, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the 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 some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Enhanced Extra (PPO) offers partial coverage for other services with no copay and no coinsurance, including a $50 quarterly over-the-counter reimbursement, meal benefits for chronic illnesses, and annual wellness exams. Acupuncture is not covered under this benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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