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Allina Health Aetna Medicare Essential (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Allina Health Aetna Medicare Essential (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 Essential (PPO) in 2025, please refer to our full plan details page.
Allina Health Aetna Medicare Essential (PPO) is a PPO plan offered by Allina Health and Aetna Insurance Holding Company available for enrollment in 2025 to people living in Brown and Nicollet Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Allina Health Aetna Medicare Essential (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 Essential (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 Essential (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.
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 $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 $7500.00 (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 $7500.00 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 Essential (PPO)
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Drug Coverage
The Allina Health Aetna Medicare Essential (PPO) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay no copay at a preferred pharmacy or through mail order, and a $12.00 copay at a standard pharmacy. For standard generic, preferred brand, and non-preferred drugs, you will pay 22% or 25% coinsurance depending on the tier. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Allina Health Aetna Medicare Essential (PPO) plan offers a range of benefits, including inpatient hospital stays with a $345 copay for the first six days, and no copay for days 7-90. Outpatient services vary in cost, with copays ranging from $0 to $450, and emergency services have a $125 copay. Primary care visits have no copay, and preventive services such as annual physical exams are also offered with no copay. This plan covers a variety of other services, such as hearing exams for $40 and vision exams with a copay between $0 and $45. Dental services are covered with a $600 annual maximum, and there are no copays for many dental services. Additional benefits include home health services with no copay, and skilled nursing facility with a $10 copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Allina Health Aetna Medicare Essential (PPO) plan. For Inpatient Hospital-Acute, you will pay a $345 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $345 copay for days 1-6, and no copay for days 7-90. Additional Days and upgrades for Inpatient Hospital-Acute, along with Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $450, and observation services, with a $450 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $45 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Allina Health Aetna Medicare Essential (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $400 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Allina Health Aetna Medicare Essential (PPO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $45 copay and no coinsurance, while Worldwide Emergency Services have a $125 copay for Worldwide Emergency and Urgent Coverage, and a $400 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $45 copay, Physician Specialist Services with a $45 copay, Mental Health Specialty Services with a $45 copay, Podiatry Services with a $45 copay, Other Health Care Professional with a copay between $0 and $45, Psychiatric Services with a $45 copay, Physical Therapy and Speech-Language Pathology Services with a $45 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with a $45 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Wigs for Hair Loss Related to Chemotherapy, with no copay. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per year, and prescription hearing aids (all types) have no copay, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay between $0 and $45, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $100 every year for both in-network and out-of-network services.
Dental Services See details
Dental Services are covered, with a $600 annual maximum benefit. The plan has a $45 copay for Medicare Dental Services, and no copay for 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. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance, and Diabetic Equipment. Diabetic Supplies have 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $35, lab services have no copay, diagnostic radiological services have a copay of up to $150, therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Allina Health Aetna Medicare Essential (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 covered by the Allina Health Aetna Medicare Essential (PPO) plan. However, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Allina Health Aetna Medicare Essential (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-46, there is a $214 copay, and for days 47-100, there is no copay. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The "Other Services" benefit covers over-the-counter items and meal benefits with no copay, and also covers annual wellness exams, screening mammography, gFOBT, and FIT with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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 are not covered.
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