Aetna Medicare Enhanced (PPO)

Aetna Medicare Enhanced (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Los Angeles and Orange Counties. 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.

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:

Drug Coverage

The Aetna Medicare Enhanced (PPO) plan features an annual prescription drug deductible of $615.00 for its enhanced alternative drug benefit. After meeting this deductible, you will enjoy no copay for Tier 1 preferred generic drugs when using preferred retail or mail-order pharmacies, while standard pharmacies charge a $12.00 copay. For other tiers, you will pay a 24% coinsurance for Tier 2 standard generics, and a 25% coinsurance for both Tier 3 preferred brands and Tier 4 non-preferred drugs. Once your total annual out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions. Additionally, the standard Part D premium of $45.00 is reduced to $33.00 for members who qualify for the low-income subsidy or Extra Help. This plan offers a clear pathway to minimized prescription costs through structured copays and coinsurance.

Additional Benefits

The Aetna Medicare Enhanced (PPO) plan provides comprehensive medical coverage with no copay for primary care physician visits, home health services, and preventive care like annual physicals. For inpatient hospital stays, members pay a daily copay of $300 for the first seven days and no copay for days eight through 90. Outpatient services and emergency care are also covered, with emergency visits requiring a $130 copay and outpatient hospital visits ranging from no copay up to a $300 copay. This plan also features valuable everyday benefits, including no copay or coinsurance for routine vision and hearing exams, alongside allowances for eyewear and prescription hearing aids. Dental care is partially covered, offering no copay for preventive services and a 20% to 50% coinsurance for comprehensive treatments up to a $1,500 annual limit. Additionally, members receive a $30 quarterly allowance for over-the-counter items and have no copay or coinsurance for diagnostic lab work.