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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 Clark and Nye Counties. This plan received an overall rating of 4.5 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 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. 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 $8950.00 (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 $8950.00 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:
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Drug Coverage
The Aetna Medicare Enhanced (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay for one, two, or three-month supplies when using a preferred pharmacy or preferred mail order. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy options. Specialty medications are only available for a one-month supply under this plan.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive care, and home health services. For specialized medical needs, members pay a $35 copay for specialist visits and a $290 copay for the first five days of an acute inpatient hospital stay, with no coinsurance required. Emergency room visits carry a $130 copay, which is waived if admitted, while urgent care services require a $35 copay. This plan also features valuable supplemental benefits, including no copays or coinsurance for routine hearing and vision exams, alongside a $250 eyewear allowance and a $1,000 hearing aid benefit per ear. Preventive dental services are covered with no copay, while comprehensive dental services require 20% to 50% coinsurance up to a $2,000 annual limit. Additionally, diagnostic lab tests, X-rays, and many medical supplies are available with no copays.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) provides partially covered inpatient hospital services with no coinsurance, requiring a $290 copay for days 1 to 5 of an acute stay and a $370 copay for days 1 to 5 of a psychiatric stay, with no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
Aetna Medicare Enhanced (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $290 for outpatient hospital services and $290 per stay for observation services. Outpatient substance abuse sessions have a $40 copay and no coinsurance, while ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (PPO) covers ambulance services with prior authorization, requiring a $325 copay and coinsurance for ground ambulance services, and a 20% coinsurance and copay for air ambulance services. Routine transportation services to health-related locations are not covered under this plan.
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 require a $35 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 $130 to $325.
Primary Care See details
Aetna Medicare Enhanced (PPO) provides primary care visits with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Therapy, mental health, and psychiatric services have copays ranging from $30 to $40 with no coinsurance, telehealth is available with a $0 to $40 copay and 20% coinsurance, and podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Enhanced (PPO) are partially covered, featuring no copay and no coinsurance for annual physicals, fitness benefits, and health education, while kidney disease education requires a 20% coinsurance and no copay. Although select benefits like chemotherapy wigs are included, several supplemental services such as weight management, nutritional training, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced (PPO) with no copay, no coinsurance, and no deductible for covered services. The plan covers one routine exam, one fitting evaluation, and up to two prescription hearing aids per year with a $1,000 maximum benefit per ear, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (PPO) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. The plan provides up to $50 annually for eye exams, which includes one routine exam, and a $250 annual combined maximum allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (PPO), offering Medicare-covered dental care for a $35 copay and no coinsurance, alongside preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive services, including restorative and endodontic care, are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit, while 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 Aetna Medicare Enhanced (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays for these services. Coinsurance for these covered benefits ranges from no coinsurance up to 20% depending on the item, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (PPO) with no copay and no coinsurance for lab services, diagnostic tests, outpatient X-rays, and diagnostic radiological services. A 20% coinsurance applies to therapeutic radiological services, and prior authorization is required for all services.
Home Health Services See details
Home health services are covered by Aetna Medicare Enhanced (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Aetna Medicare Enhanced (PPO) plan with no coinsurance. However, sub-services such as standard cardiac, intensive cardiac, and SET for PAD rehabilitation are not covered and require a $20 copay, while pulmonary rehabilitation is not covered and requires a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (PPO) partially covers other services with no copay and no coinsurance, which includes over-the-counter (OTC) items up to $35 every three months, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Acupuncture, meal benefits, and certain other services are not covered under this plan.
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