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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 Knoxville Tennessee. 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 $27.70. 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 $7750.00 (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 $7750.00 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 medications, you will pay no copay when filling your prescriptions through a preferred pharmacy or preferred mail-order service. If you choose standard pharmacy or standard mail-order options, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply. Higher-tier medications are subject to coinsurance across all pharmacy and mail-order delivery channels. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Specialty drugs under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers robust healthcare coverage with predictable costs, featuring no copay and no coinsurance for primary care doctor visits and preventive care. For specialist visits, you will pay no copay or a copay up to $45, while emergency room services carry a $130 copay. If you require hospital care, inpatient stays have no coinsurance and a $382 daily copay for the first eight days, followed by no copay for unlimited additional days. This plan also includes valuable dental, vision, and hearing benefits to help minimize your out-of-pocket expenses. You will pay no copay and no coinsurance for routine eye exams, routine hearing tests, and preventive dental care like cleanings. For comprehensive dental services and durable medical equipment, members can expect no copays and coinsurance ranging up to 50% depending on the service.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) covers inpatient acute hospital stays with no coinsurance and a $382 daily copay for days 1 to 8, with no copay for unlimited additional days. Inpatient psychiatric care is covered with no coinsurance and a $292 daily copay for days 1 to 8 (no copay for days 9 to 90); prior authorization is required for both benefits, and upgrades, non-Medicare-covered stays, and psychiatric additional days are not covered.
Outpatient Services See details
Outpatient services covered by the Aetna Medicare Enhanced (PPO) feature no coinsurance, with copays ranging from $0 to $382 for outpatient hospital services and a flat $382 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Enhanced (PPO) plan with a copay of $140.00 or $145.00 and no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (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 both. Transportation services to plan-approved or any other health-related locations are not covered.
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 are covered with a $50 copay and no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Primary Care benefits under Aetna Medicare Enhanced (PPO) are partially covered, as chiropractic and podiatry services are not covered. Patients pay no copay and no coinsurance for primary care doctor visits, while specialist visits range from a $0 to $45 copay and therapy or mental health services require a $40 copay, all with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by the Aetna Medicare Enhanced (PPO) with no copay and no coinsurance for annual physicals, fitness benefits, and screenings, though kidney education requires a 20% coinsurance and no copay. Excluded from coverage are 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
Aetna Medicare Enhanced (PPO) covers Medicare-covered hearing exams with a $45 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum per ear, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with a $0 to $45 copay and eyewear with no copay. Routine eye exams and follow-up diabetic eye exams have no copay, while eyewear including lenses, frames, and contacts is covered up to a $100 annual limit.
Dental Services See details
Aetna Medicare Enhanced (PPO) covers dental services with no copay and no coinsurance for preventive care like exams and cleanings, and a $45 copay with no coinsurance for Medicare-covered dental. Comprehensive services such as restorative care and periodontics require no copay and 20% to 50% coinsurance up to a $1,000 annual limit. The benefit is partially covered, as fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Enhanced (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced (PPO) with no copays for durable medical equipment, medical supplies, and diabetic shoes, and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Enhanced (PPO) with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic procedures carry a copay of $0 to $200 with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Aetna Medicare Enhanced (PPO) with no coinsurance, although copays apply depending on the specific service. Members will pay a $20 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily 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 required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (PPO) covers select other services with no copay and no coinsurance, including an annual wellness exam, screening mammographies, and a quarterly $15 over-the-counter (OTC) reimbursement benefit. Acupuncture, meal benefits, and some OTC list drugs are not covered under this plan.
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