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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Enhanced (PPO) is a PPO plan offered by Aetna Life Insurance Company available for the 2026 plan year to people living in Santa Barbara County. 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 $74.00. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
Drug Coverage
The Aetna Medicare Enhanced (PPO) plan features an annual prescription drug deductible of $615.00 before coverage begins. Under this plan, Tier 1 preferred generic drugs have no copay at preferred pharmacies or through preferred mail order, though standard options charge a $12.00 copay. For Tier 2 standard generic drugs, members pay a 24% coinsurance across all pharmacy types. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both carry a 25% coinsurance for all pharmacy and mail-order methods. After your annual out-of-pocket drug costs reach $2,100.00, you will pay nothing for Medicare Part D covered drugs during the catastrophic coverage phase. Additionally, the standard Part D premium is $36.20, which can be reduced to $24.20 for individuals qualifying for the full low-income subsidy.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan features no copay and no coinsurance for primary care doctor visits, routine preventive screenings, and home health services. For inpatient hospital stays, members pay a 445 dollar daily copay for the first five to six days, while emergency care carries a 130 dollar copay that is waived if admitted. Outpatient services generally require no coinsurance, with copays ranging from no copay up to 425 dollars depending on the service. Essential wellness benefits like vision and dental care are well-supported, offering no copay or coinsurance for routine eye exams, eyewear up to a 200 dollar allowance, and preventive dental cleanings. Prescription hearing aids are also covered with no copay up to 1,250 dollars per ear annually. However, members should note that certain benefits, such as routine chiropractic care, cardiac rehabilitation, and over-the-counter items, are not covered under this plan.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) covers inpatient acute hospital stays with a $445 daily copay for days 1 to 6 and no copay for days 7 to 90, and psychiatric stays with a $445 daily copay for days 1 to 5 and no copay for days 6 to 90, with no coinsurance required for either service. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Enhanced (PPO) with no coinsurance, featuring copays ranging from $0 to $425 for outpatient hospital services and a $445 copay per stay for observation services. Patients will pay a $40 copay for outpatient substance abuse sessions, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization benefits with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Enhanced (PPO), as transportation services to health-related locations are not covered. Covered ground ambulance services require a $295 copay and no coinsurance, while air ambulance services require 20% coinsurance and no copay, both requiring prior authorization.
Emergency Services See details
Aetna Medicare Enhanced (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with copays ranging from $130 to $295.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Enhanced (PPO), as podiatry services and routine chiropractic care are not covered. Patients pay no copay and no coinsurance for primary care physician visits, while other covered services require copays ranging from $15 to $40 with no coinsurance, and telehealth services require a 20% coinsurance and a $0 to $40 copay.
Preventive Services See details
Preventive Services are partially covered under the Aetna Medicare Enhanced (PPO) plan, offering no copay and no coinsurance for annual physicals, health education, and most screenings. Kidney disease education is covered with a 20% coinsurance and no copay, while several sub-services like weight management and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Enhanced (PPO), which offers annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids (all types) are covered with no copay or coinsurance up to $1,250 per ear annually, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (PPO) with no copay, no coinsurance, and no deductible for eye exams and eyewear. Members are covered for a $50 annual maximum for eye exams and a $200 annual combined allowance for eyewear, including contacts and eyeglasses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (PPO), excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Preventive care like exams, x-rays, and cleanings has no copay and no coinsurance, while Medicare-covered dental services require a $35 copay and no coinsurance. Other covered comprehensive services require no copay and a 20% to 50% coinsurance, up to a $1,000 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Enhanced (PPO) plan with prior authorization required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Enhanced (PPO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Enhanced (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, though prior authorization is required. There is no copay for these services, and coinsurance ranges from no coinsurance up to 20% depending on the item.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (PPO), with prior authorization required for both. Lab services have no copay or coinsurance, outpatient X-rays carry a $40 copay with no coinsurance, diagnostic tests and radiological services have copays ranging from $0 to $40 and $0 to $295 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Enhanced (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Aetna Medicare Enhanced (PPO), as no coverage, copays, or coinsurance are provided for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (PPO) partially covers Skilled Nursing Facility (SNF) services, which require a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and while a 3-day prior inpatient hospital stay is not necessary, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Enhanced (PPO), including annual wellness exams, screening mammography, and extra gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter items, meal benefits, and Dual Eligible SNPs with highly integrated services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
SMID: MULTIPLAN_HCIHNMEDADVRX27_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 or 1-800-MEDICARE 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.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
© 2026 Dog Media Solutions LLC. All rights reserved