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Aetna Medicare Enhanced Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Extra (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 Extra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Enhanced Extra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in SNJ Counties: ATL, BUR, CAM, CPM, CUM, GLO. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Enhanced Extra (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 Extra (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 Extra (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 $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 $13900.00 (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 $13900.00 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 Extra (PPO) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred retail pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services carry a small copay starting at $2 for Tier 1 and $12 for Tier 2 drugs for a one-month supply. For higher-tier prescriptions, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance across all pharmacy and mail-order options.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialist visits, outpatient hospital services, and diagnostic procedures, members generally face predictable costs ranging from no copay up to a $35 copay with no coinsurance. Inpatient hospital stays require a $335 daily copay for the first six days with no copay thereafter, while emergency room visits carry a $115 copay. Routine dental, vision, and hearing exams are covered with no copay, helping members easily maintain their everyday health. Skilled nursing facility stays feature no copay for the first 20 days, transitioning to a $218 daily copay for days 21 through 100. For specialized needs, medical equipment and dialysis services require no copay but carry a coinsurance of up to 20 percent.
Inpatient Hospital See details
Aetna Medicare Enhanced Extra (PPO) covers inpatient acute hospital stays with no coinsurance and a $335 daily copay for days 1 to 6, with no copay thereafter, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is covered with no coinsurance and a $346 daily copay for days 1 to 6, with no copay for days 7 to 90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services covered by Aetna Medicare Enhanced Extra (PPO) feature no coinsurance across all categories, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a copay of $0 to $335 (with a $335 copay per stay for observation services), while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization services with a copay of either $60.00 or $110.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers ground and air ambulance services with a $295 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with a $115 copay, while worldwide emergency transportation has a $295 copay, with no coinsurance up to a $250,000 maximum plan benefit.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Therapy, mental health, and psychiatric services require copays of $25 to $35 with no coinsurance, telehealth has a $0 to $40 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Enhanced Extra (PPO) partially covers preventive services with no copay and no coinsurance for annual physicals, screenings, and fitness benefits, while kidney disease education requires a 20% coinsurance and 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, readmission 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 safety devices, and counseling.
Hearing Services See details
Hearing services under the Aetna Medicare Enhanced Extra (PPO) include Medicare-covered exams for a $35 copay and no coinsurance, as well as one routine exam and one fitting evaluation annually with no copay and no coinsurance. Prescription hearing aids are partially covered for up to two aids per year with a copay between $0 and $1,700 and no coinsurance, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Enhanced Extra (PPO) with no deductibles and no coinsurance. Routine and Medicare-covered eye exams feature a $0 to $35 copay with a $50 annual limit, while eyewear is available with no copay up to a combined yearly maximum of $200.
Dental Services See details
Aetna Medicare Enhanced Extra (PPO) provides partially covered dental services, including Medicare-covered dental care with a $35 copay and no coinsurance, and routine exams, cleanings, and x-rays with no copay and no coinsurance. Non-covered services include fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Enhanced Extra (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Enhanced Extra (PPO) with no copay, though prior authorization is required. Covered items, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, feature coinsurance ranging from no coinsurance up to 20%.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $35 copay for diagnostic procedures. Covered radiological services require a $35 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology, with prior authorization required for both.
Home Health Services See details
Home health services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance. Members will pay a $20 copay for cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services, and a $15 copay for pulmonary rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance, featuring 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 inpatient hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced Extra (PPO), offering no copay and no coinsurance for chronic illness meal benefits, annual wellness exams, screening mammography, and additional gFOBT and FIT. Acupuncture and over-the-counter (OTC) items are not covered.
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