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Allina Health Aetna Medicare SmartFit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Allina Health Aetna Medicare SmartFit (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 SmartFit (PPO) in 2025, please refer to our full plan details page.
Allina Health Aetna Medicare SmartFit (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. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Allina Health Aetna Medicare SmartFit (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 SmartFit (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 SmartFit (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced 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 $590.00 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 $7000.00 (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 $7000.00 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 SmartFit (PPO)
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Drug Coverage
The Allina Health Aetna Medicare SmartFit (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic drugs, preferred brand drugs, and non-preferred drugs all have a 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Allina Health Aetna Medicare SmartFit (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services have copays from $0-$450. Primary care and preventive services have no copay, while specialist visits have a $40 copay. This plan also includes coverage for hearing, vision, and dental services. Hearing exams and hearing aids are covered, with a $40 copay for exams. Vision services, including eye exams and eyewear, are covered with no copay, and dental services have no copay for many services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $380 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $380 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Allina Health Aetna Medicare SmartFit (PPO) plan, with copays ranging from $0 to $450, depending on the service. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $35 copay per session.
Partial Hospitalization See details
Partial Hospitalization is covered by the Allina Health Aetna Medicare SmartFit (PPO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Allina Health Aetna Medicare SmartFit (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $335 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Allina Health Aetna Medicare SmartFit (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $335 copay.
Primary Care See details
The Allina Health Aetna Medicare SmartFit (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay, and specialist services cost $40. Mental health and psychiatric services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance with a $0-$40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, such as health education, and wigs for hair loss related to chemotherapy with no copay. Kidney disease education services have a 20% coinsurance, and other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, have no copay.
Hearing Services See details
Allina Health Aetna Medicare SmartFit (PPO) covers hearing exams with a $40 copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, but prescription hearing aids for the inner, outer, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$40, while routine eye exams have no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, with a combined maximum of $225 per year for eyewear.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $40 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit of $2050 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while other Medicare Part B drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Allina Health Aetna Medicare SmartFit (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $25, and lab services with no copay. Outpatient X-Ray Services have a $15 copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Allina Health Aetna Medicare SmartFit (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Allina Health Aetna Medicare SmartFit (PPO) plan. While the plan covers the benefit, the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Allina Health Aetna Medicare SmartFit (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, for days 21-42 the copay is $214, and for days 43-100, there is no copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Allina Health Aetna Medicare SmartFit (PPO) plan covers acupuncture with a $20 copay, and also covers over-the-counter items with no copay, up to a maximum of $45 every three months. This plan also covers meal benefits with no copay, and other services such as annual wellness exams and screening mammography, and gFOBT/FIT tests with no copay. However, the plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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