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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 South Dakota. 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 Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when utilizing preferred retail pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order services charge copays starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Brand-name and specialty medications are covered under coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These coinsurance rates remain consistent across both preferred and standard pharmacy options.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, annual wellness exams, and home health services. For more intensive care, inpatient hospital stays require a $300 daily copay for the first six days, while specialist visits and outpatient dental services have a $40 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care services are available for a $50 copay. This plan also features strong supplemental benefits, including no copays or coinsurance for preventive dental care up to $1,500 annually, as well as routine vision and hearing exams. Members receive up to $250 for eyewear, $1,250 for prescription hearing aids, and a $50 quarterly over-the-counter reimbursement allowance. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Aetna Medicare Enhanced Extra (PPO) partially covers inpatient hospital services with no coinsurance, excluding hospital upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute hospital stays require a $300 copay per day for days 1 through 6 (with no copay for day 7 and beyond), while psychiatric stays require a $370 copay per day for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Aetna Medicare Enhanced Extra (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $300, including $300 per stay for observation services, while outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
The Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers ground ambulance services with a $245 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. For transportation, some services are covered, but transportation to plan-approved or any health-related locations is 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 services are also covered up to a $250,000 maximum plan benefit with no coinsurance, requiring a $130 copay for emergency or urgent care and a $245 copay for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) features primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $40 copay and no coinsurance. Chiropractic and podiatry services are not covered, but telehealth benefits are available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive Services under the Aetna Medicare Enhanced Extra (PPO) are partially covered, offering an annual physical exam, health education, and select screenings with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several supplemental benefits such as in-home safety assessments, weight management, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced Extra (PPO) with no deductibles, no copays, and no coinsurance for Medicare-covered exams, one annual routine exam, and one annual fitting evaluation. Prescription hearing aids are covered up to $1,250 annually with no copay or coinsurance, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Enhanced Extra (PPO) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. The plan provides up to $50 annually for eye exams, including one routine exam, and a combined $250 annual maximum for eyewear like contacts, lenses, and frames.
Dental Services See details
Aetna Medicare Enhanced Extra (PPO) dental services are partially covered, offering Medicare-covered dental with a $40 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance up to a $1,500 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced Extra (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Enhanced Extra (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced Extra (PPO), featuring no coinsurance for diagnostic services, no copay for lab services, and diagnostic test copays ranging from $0 to $20. Radiological services require prior authorization and include a $10 copay plus coinsurance for X-rays, no copay for diagnostic radiology, and a minimum 20% coinsurance with applicable copays for therapeutic radiology.
Home Health Services See details
Aetna Medicare Enhanced Extra (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance, but only some services are covered. Standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation (with a $20 copay), pulmonary rehabilitation (with a $15 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered under this plan.
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, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced Extra (PPO) partially covers other services with no copay and no coinsurance, including a meal benefit for chronic illness, annual wellness exams, and a fifty dollar quarterly over-the-counter reimbursement allowance. Acupuncture is not covered under this plan benefit.
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