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Aetna Medicare Advantra Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra 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 Advantra Extra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Extra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Northern. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra 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 Advantra 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 Advantra Extra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $30.00. You must continue to pay paying your reduced 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 Advantra Extra (PPO) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic and Tier 2 generic medications have no copay when filled through preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order services, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply length. For brand-name and specialty medications, your costs are determined by 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 carry a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order options.
Additional Benefits
The Aetna Medicare Advantra Extra (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized medical needs, specialist visits require a $35 copay, while emergency care has a $130 copay that is waived if you are admitted. Inpatient hospital stays have no coinsurance but require daily copays, specifically $385 for days one through six of acute stays and $270 for days one through five of psychiatric stays. To support your everyday health, this plan features no deductibles and no copays for routine hearing exams and preventive dental cleanings. Additional benefits include up to $500 per ear annually for prescription hearing aids and a $1,750 annual limit for comprehensive dental care with no copay and 20% to 50% coinsurance. Durable medical equipment and diagnostic lab services are also highly accessible, requiring no copays and low to no coinsurance.
Inpatient Hospital See details
Inpatient hospital services under the Aetna Medicare Advantra Extra (PPO) are partially covered with no coinsurance, requiring prior authorization and a daily copay of $385 for days 1 to 6 of acute stays and $270 for days 1 to 5 of psychiatric stays. While subsequent days have no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Extra (PPO) covers outpatient services with no coinsurance, offering a $0 to $385 copay for outpatient hospital services and a $385 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Aetna Medicare Advantra Extra (PPO) covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Extra (PPO) covers ambulance services with prior authorization, requiring a $330 copay for ground transport and a 20% coinsurance for air transport, neither of which are waived upon hospital admission. Additional transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Advantra Extra (PPO) with a $130 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $30 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays of $130 for emergency or urgent care and $330 for emergency transportation.
Primary Care See details
Aetna Medicare Advantra Extra (PPO) covers primary care physician visits with no copay and no coinsurance, and specialist visits for a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay and no coinsurance, while mental health, psychiatric, and opioid treatments have a $35 copay and no coinsurance. Telehealth is covered with a copay ranging from no copay to $35 and 20% coinsurance, podiatry is not covered, and some chiropractic services are covered for a $15 copay and no coinsurance, excluding routine and other chiropractic care.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Advantra Extra (PPO), offering annual physical exams, health education, fitness benefits, and remote access technologies with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several other services like weight management, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Aetna Medicare Advantra Extra (PPO) offers hearing services with no deductible, featuring routine hearing exams and fitting evaluations once per year with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Advantra Extra (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with copays ranging from $0 to $35 and eyewear with no copay. The plan provides a $50 annual maximum for eye exams, which includes one routine exam per year, and a $150 combined annual limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Extra (PPO), offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive services such as restorative care and periodontics are covered up to a $1,750 annual maximum with no copay and 20% to 50% coinsurance. Fluoride, implants, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra Extra (PPO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Advantra Extra (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Advantra Extra (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Extra (PPO) covers diagnostic services with no coinsurance, including no copay for lab services and a $0 to $100 copay for diagnostic tests. Covered radiological services require a $15 copay with coinsurance for outpatient x-rays, a minimum 20% coinsurance for therapeutic radiology, and no copay for diagnostic radiology, with prior authorization required across all services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Advantra Extra (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under Aetna Medicare Advantra Extra (PPO), as standard cardiac (with a $20 copay), intensive cardiac ($20 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) services are all not covered with no coinsurance.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the Aetna Medicare Advantra Extra (PPO) are partially covered, offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $30 every three months in over-the-counter (OTC) items. Acupuncture and meal benefits are not covered under this plan.
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