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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 2026 to people living in Metro Area: Brooklyn & Queens. 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 $60.00. 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 (PPO) plan features an annual prescription 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 for any supply length up to three months. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs. For higher-tier medications, cost sharing transitions to a percentage-based coinsurance. You will pay a 24% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs across all pharmacy and mail-order options. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers comprehensive coverage with no copay or coinsurance for primary care doctor visits, preventive care, and home health services. Specialist visits, physical therapy, and outpatient mental health services require a standard copay with no coinsurance, while inpatient hospital stays incur a daily copay for the first six days. Emergency medical care is available with a $115 copay that is waived if you are admitted, while urgent care visits require a $40 copay. For additional health needs, this plan provides routine dental, vision, and hearing exams with no copay, alongside annual allowances for eyewear and prescription hearing aids. Skilled nursing facility stays feature no copay for the first 20 days, while medical equipment and dialysis services require no copay with coinsurance up to 20 percent. Additionally, diagnostic lab tests and home infusion services are covered with no copay, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) covers inpatient hospital services with no coinsurance, requiring a copay of $399 per day for days 1 to 6 of acute stays (no copay for additional days) and $346 per day for days 1 to 6 of psychiatric stays (no copay for days 7 to 90). Prior authorization is required, and the benefit is partially covered as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Enhanced (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from $0 to $399, observation services have a $399 copay per stay, and outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced (PPO) covers Medicare-approved ground and air ambulance services with a $285 copayment and no coinsurance, although prior authorization is required. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Enhanced (PPO) with a $115 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 $250,000 with no coinsurance and copays of $115 for emergency or urgent care and $285 for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Enhanced (PPO) include primary care physician visits with no copay and no coinsurance, while specialist visits cost a $45 copay and no coinsurance. Other services like physical and occupational therapy have a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered. Psychiatric, mental health, and opioid treatment services require a $45 copay and no coinsurance, while telehealth benefits have a $0 to $45 copay and 20% coinsurance.
Preventive Services See details
Preventive Services under the Aetna Medicare Enhanced (PPO) are partially covered, offering no copay and no coinsurance for annual physicals, health education, and diabetes training, though kidney disease education requires a 20% coinsurance and no copay. While select benefits like chemotherapy wigs are covered with no copay up to $400 yearly, other services including weight management, nutritional counseling, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Enhanced (PPO) offers hearing services with no coinsurance, including Medicare-covered exams for a $45 copay and annual routine exams and fittings with no copay. Prescription hearing aids are partially covered with no coinsurance and copays up to $1,700, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Enhanced (PPO) covers vision services with no coinsurance, featuring eye exams with copays ranging from no copay to $45 and a $50 annual limit. Eyewear is also covered with no copay and no coinsurance up to a combined maximum of $100 per year for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Enhanced (PPO), offering Medicare-covered dental services for a $45 copay and no coinsurance, and preventive care like cleanings, exams, and X-rays with no copay and no coinsurance. However, fluoride, restorative, endodontic, periodontic, prosthodontic, implant, and oral surgery 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 carries a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Enhanced (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Enhanced (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $45, while lab services and diagnostic radiological services have no copay. Outpatient X-rays require a $45 copay, and therapeutic radiological services carry a minimum 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
Aetna Medicare Enhanced (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, but only some services are covered as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for peripheral artery disease are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by Aetna Medicare Enhanced (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not required for admission, additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Enhanced (PPO) partially covers other services, offering acupuncture for a $45 copay and no coinsurance for up to 12 treatments per year, alongside chronic illness meals and select wellness screenings with no copay or coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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