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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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Allina Health Aetna Medicare Enhanced (PPO) is a PPO plan offered by Allina Health and Aetna Insurance Company available for the 2026 plan year to people living in Brown and Nicollet 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 $94.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6350.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6350.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 has an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using preferred retail pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs. Higher-tier medications require coinsurance instead of flat copayments regardless of the pharmacy type you choose. Tier 3 preferred brand drugs require a 24% coinsurance for all supply durations and pharmacy choices. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, though specialty medications are limited to a one-month supply.
Additional Benefits
The Allina Health Aetna Medicare Enhanced (PPO) plan offers robust medical coverage with no copay for primary care visits and routine preventive screenings. For more specialized care, members pay a $45 copay for specialist visits and a $600 copay per inpatient hospital admission with no coinsurance. Emergency services require a $130 copay, which is waived if admitted, while urgent care visits carry a $50 copay. This plan also includes valuable everyday wellness benefits, featuring no copays for routine dental, vision, and hearing exams. Members receive up to $1,000 annually for comprehensive dental care with 20% to 50% coinsurance, a $150 annual allowance for eyewear, and up to $500 per ear yearly for prescription hearing aids. Additionally, the plan covers home health services and provides a $30 quarterly allowance for select over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Allina Health Aetna Medicare Enhanced (PPO) with a $600 copay per admission and no coinsurance for both acute and psychiatric stays. While unlimited additional acute care days are covered with no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $375, plus a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copays or coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Allina Health Aetna Medicare Enhanced (PPO) plan with a copay of $140.00 or $145.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers ground ambulance services with a $340 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance, requiring a $130 copay for emergency or urgent care and a $340 copay for emergency transportation.
Primary Care See details
Allina Health Aetna Medicare Enhanced (PPO) primary care benefits are partially covered, excluding podiatry and non-routine chiropractic services. Most covered services feature no coinsurance, with no copay for primary care visits, a $15 copay for routine chiropractic care, and a $45 copay for specialist, therapy, psychiatric, mental health, and opioid treatment services, while telehealth carries a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Allina Health Aetna Medicare Enhanced (PPO) features partially covered preventive services with no copay and no coinsurance for annual physical exams, health education, memory fitness, and various screenings, while kidney disease education requires a 20% coinsurance with no copay. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Allina Health Aetna Medicare Enhanced (PPO), featuring Medicare-covered exams for a $45 copay and no coinsurance, alongside annual routine exams and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Allina Health Aetna Medicare Enhanced (PPO) with no deductibles and no coinsurance, featuring no copay for routine annual eye exams and a $0 to $45 copay for Medicare-covered exams. Covered eyewear, including lenses, frames, and contacts, has no copay up to a combined annual maximum benefit of $150, while eye exams have a $50 annual maximum.
Dental Services See details
Dental services are partially covered by Allina Health Aetna Medicare Enhanced (PPO), featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive care like cleanings and x-rays. Comprehensive dental options are covered up to a $1,000 annual limit with no copay and 20% to 50% coinsurance, although fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Allina Health Aetna Medicare Enhanced (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Allina Health Aetna Medicare Enhanced (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Allina Health Aetna Medicare Enhanced (PPO) with no copays for durable medical equipment (DME), prosthetics, and diabetic services. Coinsurance ranges from no coinsurance to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Allina Health Aetna Medicare Enhanced (PPO), with prior authorization required. Outpatient diagnostic tests have no coinsurance and a $0 to $40 copay, while lab and diagnostic radiological services have no copay and no coinsurance. Therapeutic radiological services require both a copay and a minimum 20% coinsurance, and outpatient X-rays carry a $30 copay and coinsurance.
Home Health Services See details
Allina Health Aetna Medicare Enhanced (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Allina Health Aetna Medicare Enhanced (PPO) provides Cardiac Rehabilitation Services with no coinsurance, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. While there is no coinsurance for covered services, the non-covered rehabilitation programs list copays ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Allina Health Aetna Medicare Enhanced (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 50, and no copay for days 51 to 100. Prior authorization is required, and while a 3-day inpatient hospital stay is not required prior to admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered under the Allina Health Aetna Medicare Enhanced (PPO) include acupuncture with a $20 copay and no coinsurance for up to 12 treatments annually. Over-the-counter items up to $30 every three months, chronic illness meal benefits, annual wellness exams, screening mammographies, and select colorectal screenings are also covered with no copay and no coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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