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Allina Health Aetna Medicare Grand Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Allina Health Aetna Medicare Grand Extra (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 Grand Extra (PPO) in 2026, please refer to our full plan details page.
Allina Health Aetna Medicare Grand Extra (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 Grand 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 Allina Health Aetna Medicare Grand 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 Allina Health Aetna Medicare Grand Extra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $154.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5300.00 (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 $5300.00 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 Grand Extra (PPO)
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Drug Coverage
The Allina Health Aetna Medicare Grand Extra (PPO) plan features a $0 drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when utilizing preferred pharmacies or preferred mail order services. If you choose a standard pharmacy or standard mail order, copays start at $2 for Tier 1 drugs and $12 for Tier 2 drugs for a one-month supply. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. You will pay a 21% coinsurance for Tier 3 preferred brand drugs, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 33% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order channels.
Additional Benefits
The Allina Health Aetna Medicare Grand Extra (PPO) offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialist visits, urgent care, and outpatient services, patients can expect low copays generally ranging from no copay to $15 with no coinsurance. Inpatient hospital stays require a $175 copay per stay with no coinsurance, while emergency room visits carry a $150 copay that is waived if you are admitted. This plan also provides valuable supplemental benefits, including dental coverage with no copay for most preventive and comprehensive care up to a $2,100 annual limit. Vision and hearing benefits feature no copays for routine exams, alongside a $275 annual eyewear allowance and up to $1,500 per ear for prescription hearing aids. Additionally, members can access a quarterly $75 allowance for over-the-counter items with no copay, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Allina Health Aetna Medicare Grand Extra (PPO) inpatient hospital benefits are partially covered, featuring a $175 copay per stay and no coinsurance for Medicare-covered acute and psychiatric admissions. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Allina Health Aetna Medicare Grand Extra (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services have a copay ranging from $0 to $175, while outpatient substance abuse individual and group sessions require a $15 copay.
Partial Hospitalization See details
Allina Health Aetna Medicare Grand Extra (PPO) covers partial hospitalization benefits with a copay of $75 or $180 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Allina Health Aetna Medicare Grand Extra (PPO), featuring a $250 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Allina Health Aetna Medicare Grand Extra (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $150 to $250.
Primary Care See details
Allina Health Aetna Medicare Grand Extra (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, therapy, mental health, and podiatry services generally require a $15 copay and no coinsurance. Chiropractic services are partially covered, with routine care costing a $20 copay and no coinsurance, though other chiropractic services are not covered. Additional telehealth benefits are also available with a $0 to $15 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by the Allina Health Aetna Medicare Grand Extra (PPO), featuring no copay and no coinsurance for annual physicals, health education, memory fitness, and select screenings. Kidney disease education has no copay but requires a 20% coinsurance, whereas sub-services like medical nutrition therapy, weight management, counseling, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Allina Health Aetna Medicare Grand Extra (PPO), offering Medicare-covered exams for a $15 copay and no coinsurance, and annual routine exams and fittings with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no copay or coinsurance up to $1,500 per ear yearly, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Allina Health Aetna Medicare Grand Extra (PPO) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. This benefit includes one annual routine eye exam with a $50 maximum benefit, as well as a combined $275 yearly allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Allina Health Aetna Medicare Grand Extra (PPO), featuring a $2,100 annual maximum benefit for both in-network and out-of-network care. Most covered preventive and comprehensive services have no copay and no coinsurance, while Medicare-covered dental services require a $15 copay and no coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Allina Health Aetna Medicare Grand Extra (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, covered Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Allina Health Aetna Medicare Grand Extra (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Allina Health Aetna Medicare Grand Extra (PPO) with no copays and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and diabetic supplies. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Allina Health Aetna Medicare Grand 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, while radiological services require a $15 copay plus coinsurance for X-rays, a minimum 20% coinsurance for therapeutic services, and no minimum copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by Allina Health Aetna Medicare Grand Extra (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Allina Health Aetna Medicare Grand Extra (PPO) plan. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and carry copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Allina Health Aetna Medicare Grand Extra (PPO) with no coinsurance, though prior authorization is required and additional days beyond the Medicare limit are not covered. There is no copay for days 1 through 20 and days 37 through 100, while days 21 through 36 require a $218 daily copay, with no prior three-day hospital stay required.
Other Services See details
Other Services are partially covered under the Allina Health Aetna Medicare Grand Extra (PPO), excluding Dual Eligible SNPs with Highly Integrated Services. Acupuncture is covered with a $20 copay and no coinsurance for up to 12 treatments annually, while over-the-counter items (up to $75 quarterly), meal benefits, annual wellness exams, and additional cancer screenings feature no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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