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Allina Health Aetna Medicare Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Allina Health 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 Allina Health Aetna Medicare Enhanced (PPO) in 2026, please refer to our full plan details page.
Allina Health Aetna Medicare Enhanced (PPO) is a PPO plan offered by Allina Health and Aetna Insurance Holding Company available for enrollment in 2025 to people living in Twin Cities Metro and Select MN Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Allina Health 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 Allina Health 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 Allina Health Aetna Medicare Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.00. 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 $300.00 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 $6000.00 (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 $6000.00 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 Allina Health Aetna Medicare Enhanced (PPO)
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Drug Coverage
The Allina Health Aetna Medicare Enhanced (PPO) plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a copay starting at $2.00. Tier 2 generic medications cost a $10.00 copay for a one-month supply at preferred pharmacies and preferred mail-order, compared to a $12.00 copay at standard pharmacies. For Tier 3 preferred brand drugs, you will pay a 25% coinsurance, while Tier 4 non-preferred drugs require a 26% coinsurance across all pharmacy and mail-order options. Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply at both standard and preferred locations.
Additional Benefits
The Allina Health Aetna Medicare Enhanced (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. Inpatient hospital stays require a $395 copay per stay with no coinsurance, while outpatient hospital services feature a copay ranging from no copay up to $350. Emergency care is available with a $150 copay, which is waived if admitted within 24 hours, and urgent care has a $25 copay. Supplemental benefits include dental and vision care, both featuring no copay and no coinsurance for most routine services. Vision benefits include a $250 annual eyewear allowance, dental care is covered up to a $1,500 annual limit, and hearing aids are covered up to $750 per ear annually with no copay. Additionally, beneficiaries can access over-the-counter items with no copay up to $60 every three months and skilled nursing facility stays with no copay for days 1 to 20.
Inpatient Hospital See details
Inpatient hospital services are covered by Allina Health Aetna Medicare Enhanced (PPO) with a $395 copayment per stay and no coinsurance, though prior authorization is required. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay or coinsurance, while outpatient substance abuse sessions require a $25 copay with no coinsurance.
Partial Hospitalization See details
Allina Health Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copay of either $75.00 or $180.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers ambulance services with prior authorization, requiring a $300 copay for ground ambulance and a 20% coinsurance for air ambulance. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by the Allina Health Aetna Medicare Enhanced (PPO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $150 to $300.
Primary Care See details
Allina Health Aetna Medicare Enhanced (PPO) features primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and podiatry services range from a $0 to $25 copay with no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance for up to 12 routine visits per year, though other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $25 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by the Allina Health Aetna Medicare Enhanced (PPO) with no copay and no coinsurance for annual physicals, diabetes training, and glaucoma screenings, while kidney disease education has no copay but requires a 20% coinsurance. Covered supplemental benefits like health education, memory fitness, remote access, and chemotherapy wigs (up to $400 annually) feature no copay and no coinsurance. Services not covered include in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home/bathroom safety devices, counseling, post-discharge medication reconciliation, and re-admission prevention.
Hearing Services See details
Hearing services covered under the Allina Health Aetna Medicare Enhanced (PPO) include annual routine exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $750 per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Allina Health Aetna Medicare Enhanced (PPO) vision services are fully covered with no copay, no coinsurance, and no deductible for both exams and eyewear. Beneficiaries receive one routine eye exam per year with a $50 annual limit, alongside a combined yearly eyewear allowance of $250 for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by the Allina Health Aetna Medicare Enhanced (PPO), offering no copay and no coinsurance for most preventive and comprehensive services up to a $1,500 annual limit. Medicare-covered dental services require a $25 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Allina Health Aetna Medicare Enhanced (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Allina Health Aetna Medicare Enhanced (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 may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic tests for a $0 to $20 copay with no coinsurance, and lab services with no copay. Diagnostic radiological services have no copay, outpatient X-rays require a $15 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Allina Health Aetna Medicare Enhanced (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Allina Health Aetna Medicare Enhanced (PPO) with no coinsurance, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require copays ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Allina Health Aetna Medicare Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and days 39 to 100, and a $218 daily copay for days 21 to 38. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers acupuncture with a $20 copay and no coinsurance, up to 12 treatments per year. Other covered services—including over-the-counter items (up to $60 every three months via reimbursement), chronic illness meal benefits, annual wellness exams, and additional cancer screenings—are fully covered with no copay and no coinsurance.
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