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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 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 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 $104.00. 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 Extra (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a preferred retail pharmacy or preferred mail-order service. If standard pharmacies or standard mail-order options are used, Tier 1 drugs carry a copay starting at $2.00, while Tier 2 drugs start at a $12.00 copay for a one-month supply. For brand-name and specialty prescriptions, cost sharing shifts to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply uniformly across preferred and standard pharmacies, as well as mail-order services.
Additional Benefits
The Aetna Medicare Enhanced Extra (PPO) plan offers robust coverage with many essential services featuring no copay and no coinsurance. Members enjoy no copay for primary care physician visits, routine dental cleanings, routine eye exams, and home health services. For specialized care, the plan features predictable copays and no coinsurance, including a $40 copay for specialist visits and a $130 copay for emergency room visits. If you require hospital care, inpatient stays carry a $399 daily copay for the first six days and no copay thereafter, while skilled nursing facility stays have no copay for the first 20 days. Diagnostic lab services and home infusion drugs also feature no copay, while durable medical equipment requires no copay with coinsurance ranging up to 20%. Overall, this PPO plan provides strong financial protection by eliminating coinsurance on the majority of covered medical, vision, and dental benefits.
Inpatient Hospital See details
Aetna Medicare Enhanced Extra (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $399 daily copay for days 1 through 6 and no copay for additional days, while psychiatric stays require a $346 daily copay for days 1 through 6 and no copay for days 7 through 90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Enhanced Extra (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which also require no copay. Outpatient hospital services have a copay of $0 to $395, observation services require a $399 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced Extra (PPO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Enhanced Extra (PPO) covers Medicare-approved ground and air ambulance services with a $265 copay and no coinsurance, though prior authorization is required. Additional transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Enhanced Extra (PPO) offers 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 have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $130 to $265 up to a $250,000 lifetime limit.
Primary Care See details
Aetna Medicare Enhanced Extra (PPO) features primary care physician visits with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and mental health services require a $40 copay and no coinsurance. Additional telehealth services are available with a $0 to $50 copay and 20% coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Enhanced Extra (PPO), with most covered services, such as annual physical exams and glaucoma screenings, requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Several supplemental benefits are not covered under this plan, including in-home safety assessments, personal emergency response systems, weight management programs, and nutritional/dietary benefits.
Hearing Services See details
Hearing services under Aetna Medicare Enhanced Extra (PPO) include routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays up to $1,700, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Enhanced Extra (PPO) covers vision services with no coinsurance, offering eye exams with a $0 to $40 copay (including routine exams with no copay) up to a $50 annual maximum. Eyewear, including lenses, frames, and contacts, is covered with no copay and no coinsurance up to a $150 combined annual limit.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Enhanced Extra (PPO) plan, featuring Medicare-covered dental services for a $40 copay and no coinsurance. Routine preventive services like oral exams, cleanings, and x-rays are available with no copay and no coinsurance, while fluoride, restorative services, endodontics, periodontics, prosthodontics, implants, orthodontics, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Enhanced Extra (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Enhanced Extra (PPO) plan 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 prior authorization required. Coinsurance ranges from 0% to 19% for durable medical equipment and prosthetics, and up to 20% for diabetic equipment, with diabetic supplies limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced Extra (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $40 copay for diagnostic tests, while radiological services include a $0 minimum copay for diagnostic radiology, a $40 copay for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Enhanced Extra (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Aetna Medicare Enhanced Extra (PPO) plan, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Enhanced Extra (PPO), which offers a meal benefit for chronic illness, an annual wellness exam, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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