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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 Jackson and Josephine 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.
For Aetna Medicare Enhanced (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling your prescription through a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, copays start at $2 for Tier 1 drugs and $12 for Tier 2 drugs for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance across all pharmacy and mail-order options. This plan offers significant savings on generic medications, making it a strong option if your regular prescriptions fall into the lower tiers.
Additional Benefits
The Aetna Medicare Enhanced (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, annual physicals, and home health care. Specialist visits feature a copay of up to $35 with no coinsurance, while inpatient hospital stays require a daily copay of $475 for the first five days of acute care. Outpatient hospital services range from no copay up to a $400 copay with no coinsurance. This plan also includes essential supplemental benefits, providing no copay for preventive dental, routine vision, and routine hearing exams. Members benefit from a $175 annual eyewear allowance, up to $1,250 per ear annually for prescription hearing aids, and a $30 quarterly over-the-counter item allowance. Diagnostic lab tests and x-rays are covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Enhanced (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $475 daily copay for days 1-5 of acute stays and a $415 daily copay for days 1-5 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Enhanced (PPO) are covered with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services and a $475 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Enhanced (PPO) covers partial hospitalization services with a copayment of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Enhanced (PPO) plan require prior authorization, featuring a $275 copay for ground transport and a 20% coinsurance for air transport. While some transportation services are covered, transport to plan-approved or other health-related locations is not covered.
Emergency Services See details
Aetna Medicare Enhanced (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, with no coinsurance for either service. Worldwide emergency and urgent care are also covered with a $115 copay, while worldwide emergency transportation requires a $275 copay, up to a maximum plan benefit of $250,000 with no coinsurance.
Primary Care See details
Aetna Medicare Enhanced (PPO) provides primary care visits with no copay and no coinsurance, and specialist visits with no copay to a $35 copay and no coinsurance. Physical, occupational, speech, mental health, and opioid therapies are covered with a $35 to $40 copay and no coinsurance, while telehealth services require no copay to a $40 copay and 20% coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Enhanced (PPO) partially covers preventive services, offering annual physicals, glaucoma screenings, and select fitness benefits with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance with no copay. Supplemental options like personal emergency response systems, weight management, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Aetna Medicare Enhanced (PPO) partially covers hearing services, providing Medicare-covered exams, annual routine exams, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear every year with no copay and no coinsurance, though OTC hearing aids as well as 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 copays, no coinsurance, and no deductibles for eye exams and eyewear. The plan offers a $50 annual maximum for eye exams, including one routine exam per year, and a $175 annual allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Enhanced (PPO), with exclusions for other diagnostic dental, fluoride, other preventive dental, maxillofacial prosthetics, implants, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, while covered preventive services have no copay and no coinsurance, and covered comprehensive services have no copay and 20% to 50% coinsurance up to a $1,250 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Aetna Medicare Enhanced (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Medicare Part B chemotherapy and other Part B drugs are subject to a coinsurance ranging from 0% to 20%.
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 this coverage.
Medical Equipment See details
Aetna Medicare Enhanced (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic therapeutic shoes and inserts are covered with no copay, while diabetic supplies require no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Enhanced (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $15 copay for diagnostic tests, while radiological services range from no copay for diagnostic radiology and X-rays to a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Aetna Medicare Enhanced (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Enhanced (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Enhanced (PPO) partially covers Skilled Nursing Facility (SNF) care 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, a prior three-day hospital stay is not required, and 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 select benefits like over-the-counter items up to $30 every three months, annual wellness exams, and additional screenings with no copay and no coinsurance. However, acupuncture, meal benefits, and certain over-the-counter drugs are not covered.
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