A non-government entity
Aetna Medicare Enhanced Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Plus (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 Plus (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Central and Southwest Virginia 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 Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $1000.00 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 $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 Aetna Medicare Enhanced Plus (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 Plus (PPO) plan features an annual prescription drug deductible of $615. For generic medications, members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options are also available with low copays starting at just $2 for Tier 1 and $12 for Tier 2 drugs. Brand-name and specialty medications under this plan are covered under 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 both carry a 25% coinsurance across all pharmacy and mail-order options. This structure offers a clear path to saving money on generic prescriptions while providing steady coverage for brand-name drugs.
Additional Benefits
The Aetna Medicare Enhanced Plus (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, while specialist visits require a copay of up to $20. Inpatient hospital stays require a daily copay of $382 for the first eight days of acute stays, whereas outpatient hospital services range from no copay up to $382 with no coinsurance. Emergency care is covered with a $130 copay, which is waived if you are admitted within 24 hours. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing care with no copay. Prescription hearing aids are covered up to a $2,000 annual limit per ear, eyewear is covered up to a $175 annual maximum, and comprehensive dental services require a 20% to 50% coinsurance up to a $750 limit. Additionally, members receive home health services with no copay and a $30 quarterly reimbursement for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Enhanced Plus (PPO) with no coinsurance, requiring a daily copay of $382 for days 1-8 of acute stays and $292 for days 1-8 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and certain services like non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced Plus (PPO) outpatient services are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $382, observation services carry a $382 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Enhanced Plus (PPO) with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Plus (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Enhanced Plus (PPO) covers emergency services with a $130 copay (waived if admitted 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 limit with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Enhanced Plus (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $20 copay and no coinsurance. Physical, occupational, and speech therapy require a $20 copay with no coinsurance, while mental health, psychiatric, and opioid treatment require a $45 copay with no coinsurance. Telehealth benefits are available with a $0 to $50 copay and 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Aetna Medicare Enhanced Plus (PPO) plan, with most covered benefits, including annual physicals and screenings, requiring no copay and no coinsurance, while kidney disease education features no copay and a 20% coinsurance. Services not covered by this plan include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced Plus (PPO), offering Medicare-covered exams for a $20 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $2,000 annual limit per ear, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Enhanced Plus (PPO) covers vision services with no deductibles and no coinsurance, offering routine eye exams with no copay and Medicare-covered eye exams with a copay of up to $20. Eyewear, including lenses and frames, is covered with no copay up to a combined maximum annual benefit of $175.
Dental Services See details
Aetna Medicare Enhanced Plus (PPO) partially covers dental services, offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $20 copay and no coinsurance. Comprehensive services such as restorative care and endodontics are covered with no copay and 20% to 50% coinsurance up to a $750 annual limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced Plus (PPO) 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 no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced Plus (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced Plus (PPO) and generally requires prior authorization. Durable medical equipment and medical supplies feature no copay and coinsurance ranging from no coinsurance to 20%, while prosthetic devices carry no copay with 20% coinsurance, and diabetic therapeutic shoes or inserts have no copay.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Plus (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays. Diagnostic procedures feature no coinsurance and a copay ranging from $0 to $100, while diagnostic radiological services start at a $0 copay and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Enhanced Plus (PPO) with no coinsurance, but some services are not covered in practice. Specifically, standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $200 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day inpatient hospital stay is not, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under Aetna Medicare Enhanced Plus (PPO) are partially covered with no copay and no coinsurance for benefits such as chronic illness meals, wellness exams, additional cancer screenings, and up to $30 quarterly in over-the-counter item reimbursements. However, acupuncture and certain other 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