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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 Metro: Bronx. 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 $51.00. 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 $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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using a preferred retail pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drug copays range from $2 to $6, and Tier 2 drug copays range from $12 to $36 depending on the supply fill. Higher-tier medications under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, with specialty prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers robust medical coverage with many essential services featuring no copay and no coinsurance. Beneficiaries pay no copay for primary care physician visits, annual physicals, and preventive dental and vision exams. Specialist visits require a copay of up to $45, while emergency room care has a $115 copay that is waived upon hospital admission. For rehabilitation and recovery, the plan covers home health services and cardiac rehabilitation with no copay. Skilled nursing facility stays require no copay for the first 20 days, and durable medical equipment is available with no copay and coinsurance up to 20%. While routine hearing and vision exams have no copay, advanced benefits like hearing aids and prescription eyewear have specific copays and annual coverage limits.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Enhanced Extra (PPO) with no coinsurance, requiring a $399 daily copay for days 1 through 6 of acute stays (no copay thereafter) and a $346 daily copay for days 1 through 6 of psychiatric stays (no copay for days 7 through 90). This benefit is partially covered, as upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Enhanced Extra (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services have copays ranging from $0 to $399, while outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Transportation services are not covered.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) covers emergency services with a $115 copay (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 up to a $250,000 maximum benefit limit with no coinsurance, featuring a $115 copay for emergency or urgent care and a $290 copay for emergency transportation.
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 $45 copay and no coinsurance. Physical, occupational, and speech therapy require a $35 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance for most services, including annual physical exams, glaucoma screenings, and fitness benefits, though kidney disease education requires a 20% coinsurance. This benefit is partially covered, as sub-services such as weight management, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced Extra (PPO), featuring a $45 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. While up to two prescription hearing aids per year are covered with no coinsurance and copays ranging from $0 to $1,700, OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced Extra (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with copays ranging from no copay up to $45 and eyewear with no copay. Covered eye exams have a maximum annual benefit of $50, while eyewear—including contact lenses, eyeglasses, and upgrades—is covered up to a combined maximum of $100 per year.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Enhanced Extra (PPO), featuring a $45 copay and no coinsurance for Medicare-covered dental care. Preventive services like cleanings, oral exams, and dental X-rays are available with no copay and no coinsurance, but other services including fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced Extra (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced Extra (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced Extra (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay for all covered items. Prior authorization is required, and coinsurance ranges from no coinsurance to 20% depending on the specific equipment or supply.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $45 copay for diagnostic tests. Radiological services require a $45 copay for X-rays, no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the 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 copay and no coinsurance, meaning some services are covered, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Extra (PPO) covers Skilled Nursing Facility (SNF) services 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, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services are partially covered by the Aetna Medicare Enhanced Extra (PPO) plan, offering a meal benefit, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and Dual Eligible SNPs are not covered under this benefit.
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