A non-government entity
Aetna Medicare Enhanced (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for 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 Aetna Medicare Enhanced (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in El Paso County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that 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 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 Aetna Medicare Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $615.00 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 $6750.00 (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 $6750.00 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 Aetna Medicare Enhanced (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Enhanced (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply duration. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail order options. Tier 5 specialty drugs are restricted to a one-month supply at the 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers comprehensive coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits range from no copay up to a $40 copay, while inpatient hospital stays require daily copays for the first several days but carry no coinsurance. Emergency care is accessible with a $130 copay, which is waived if you are admitted, alongside no copays for ambulatory surgical services. For routine wellness, the plan provides preventive dental and vision care with no copays, plus a $175 annual allowance for contacts and eyeglasses. Routine hearing exams are also fully covered with no copay, and prescription hearing aids are partially covered up to a $500 annual limit per ear. Additionally, members benefit from a $30 quarterly allowance for over-the-counter items and no copays for diagnostic lab tests and outpatient X-rays.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays incur a $450 copay for days 1 to 6 with no copay for days 7 and beyond, while psychiatric stays require a $375 copay for days 1 to 5 and no copay for days 6 to 90. Some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Aetna Medicare Enhanced (PPO) covers outpatient services with no coinsurance, including a $0 to $300 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (PPO) covers ground ambulance services with a $275 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Enhanced (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, and worldwide emergency services are covered up to $250,000 with no coinsurance and copays of $130 for emergency or urgent care and $275 for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Covered therapy, psychiatric, and mental health services generally require a $40 copay and no coinsurance, while telehealth options carry a $0 to $50 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Enhanced (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, health education, and screenings, though kidney disease education carries a 20% coinsurance and no copay. Supplemental options like medical nutrition therapy, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced (PPO), including Medicare-covered exams for a $40 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 annual maximum per ear, but OTC, inner ear, outer ear, and over-the-ear devices are not covered.
Vision Services See details
Aetna Medicare Enhanced (PPO) covers vision services with no copay and no coinsurance, including eye exams and eyewear. The plan features no deductible and provides up to $50 annually for eye exams and a combined $175 annual allowance for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (PPO), offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 20% to 50% coinsurance up to a $1,000 annual limit. Medicare-covered dental requires a $40 copay and no coinsurance, while fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (PPO) covers medical equipment with no copays, including durable medical equipment (DME), prosthetics, and diabetic supplies. Under this plan, DME, medical supplies, and diabetic supplies require no coinsurance to 20% coinsurance, while prosthetic devices carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (PPO) covers diagnostic and radiological services, though prior authorization is required. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $50, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Enhanced (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Enhanced (PPO) partially covers other services, providing no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT tests, and up to $30 every three months in over-the-counter (OTC) item reimbursements. However, acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved