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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 Northern New Jersey. 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 $91.00. 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) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you pay no copay for any supply duration when using a preferred retail pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options charge copays starting at $2.00 for Tier 1 and $12.00 for Tier 2 one-month supplies. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance, with specialty medications limited to a one-month supply. Choosing preferred network pharmacies and mail-order services helps minimize your out-of-pocket prescription costs under this PPO plan.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits and urgent care require low copays and no coinsurance, while outpatient hospital services feature copays up to $350. For hospital stays, members pay daily copays for the first six days of inpatient acute or psychiatric care, with no copay for subsequent days. This plan also includes valuable dental, vision, and hearing benefits to help lower your out-of-pocket costs. Routine dental and vision services, including eye exams and eyewear, feature no copays, alongside a $1,000 annual maximum benefit for dental care. Additionally, skilled nursing facility stays require no copay for the first 20 days, and medical equipment is covered with no copay and coinsurance up to 20%.
Inpatient Hospital See details
Aetna Medicare Enhanced Extra (PPO) partially covers inpatient hospital services with no coinsurance, featuring a $390 daily copay for days 1 to 6 of acute stays (with no copay for days 7 and beyond, including unlimited additional days) and a $346 daily copay for days 1 to 6 of psychiatric stays (with no copay for days 7 to 90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced Extra (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $350, observation services cost a $390 copay per stay, and 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 services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers ground and air ambulance services with a $285 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $40 copay and no coinsurance. Worldwide emergency services are also covered with no coinsurance up to a $250,000 limit, with a $115 copay for emergency or urgent care and a $285 copay for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) offers primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while mental health, psychiatric, and opioid treatments have a $35 copay and no coinsurance. Telehealth services carry a $0 to $40 copay and 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Enhanced Extra (PPO) covers annual physical exams, diabetes training, and glaucoma screenings with no copay and no coinsurance, while kidney disease education has a 20% coinsurance and no copay. Additional preventive benefits are partially covered, offering health education, fitness, and chemotherapy wigs (up to $400 annually) with no copay or coinsurance, whereas services like weight management, nutritional benefits, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Enhanced Extra (PPO), which offers Medicare-covered exams for a $35 copay and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Enhanced Extra (PPO) covers vision services with no coinsurance and no deductibles, offering eye exams with a copay ranging from $0 to $35 and eyewear with no copay. Routine eye exams (limited to one per year) and eyewear—including contacts and eyeglasses—are covered up to annual maximum benefits of $50 and $150 respectively.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced Extra (PPO) with a combined in- and out-of-network annual maximum benefit of $1,000. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Enhanced Extra (PPO) covers dialysis services with no copay and a 20% coinsurance, although 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 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 Extra (PPO) with prior authorization, featuring a $0 to $35 copay and no coinsurance for diagnostic tests, and no copay or coinsurance for lab services. Radiological benefits range from a $0 minimum copay for diagnostic radiology to a 20% coinsurance for therapeutic services, and a $35 copay with coinsurance for X-rays.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Enhanced Extra (PPO) plan 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, but only some services are covered; standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays between $15 and $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Enhanced Extra (PPO) partially covers other services, offering a chronic illness meal benefit, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered under this plan.
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