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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 MI Southwest and Southeast. 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 $72.00. 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 $10100.00 (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 $10100.00 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 using a preferred pharmacy or preferred mail-order service. If you choose standard pharmacies or standard mail order, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For higher-tier medications, costs shift to coinsurance. 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 both carry a 25% coinsurance, with specialty tier coverage restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits and a $40 copay for specialists. If you require hospital services, inpatient stays feature a $325 daily copay for the first seven days and no copay thereafter, while outpatient hospital services carry copays ranging from no copay up to $325. Emergency care is available with a $130 copay, which is waived if you are admitted within 24 hours, and urgent care visits require a $35 copay. This plan also includes strong routine care benefits, featuring no copays for preventive dental cleanings, routine vision exams, and annual hearing tests. You can take advantage of allowances for extras, including up to $250 annually for eyewear, up to $1,000 per ear for prescription hearing aids, and a $60 reimbursement every three months for over-the-counter items. Additionally, many diagnostic services, lab tests, and home health services are covered with no copay.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a $325 daily copay for days 1 through 7, followed by no copay for days 8 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Enhanced (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a copay ranging from $0 to $325, while observation services cost a $325 copay per stay and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Enhanced (PPO) with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (PPO) covers ambulance services requiring prior authorization, with a $250 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport. Although some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
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, and urgently needed care with a $35 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 maximum limit with no coinsurance and copays of $130 for emergency or urgent care and $250 for emergency transportation.
Primary Care See details
Aetna Medicare Enhanced (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 copay and no coinsurance, podiatry is not covered, and some chiropractic services are covered though routine and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Enhanced (PPO) offers preventive services with no copay and no coinsurance for annual physical exams, select screenings, and fitness benefits, though kidney disease education requires no copay and a 20% coinsurance. The benefit is partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission 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 safety devices, and counseling.
Hearing Services See details
Aetna Medicare Enhanced (PPO) covers hearing services, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 yearly maximum per ear; however, OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Enhanced (PPO) with no coinsurance and no deductibles, featuring no copay for routine eye exams and a copay of $0 to $40 for other eye exams up to a $50 annual limit. Covered eyewear, including contacts and eyeglasses, also has no copay and is subject to a $250 annual combined maximum benefit.
Dental Services See details
Aetna Medicare Enhanced (PPO) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, alongside preventive services like exams, cleanings, and x-rays for no copay and no coinsurance. Comprehensive services including restorative, endodontics, periodontics, prosthodontics, and oral surgery are covered with no copay and 20% to 50% coinsurance, but fluoride, other diagnostic or preventive services, maxillofacial prosthetics, implants, and orthodontics 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, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Enhanced (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Enhanced (PPO) with no copays for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Coinsurance for these services ranges from no coinsurance up to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures and tests carry a $0 to $75 copay and no coinsurance, while lab, diagnostic radiological, and outpatient X-ray services have no copay and no coinsurance. Therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Enhanced (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Aetna Medicare Enhanced (PPO); however, while some services are covered, specific programs like cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and carry copays ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (PPO) partially covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Enhanced (PPO) partially covers other services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include chronic illness meals, annual wellness exams, supplemental screenings, and up to $60 every three months in reimbursement for over-the-counter items.
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