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Aetna Medicare Enhanced Extra (PPO) - H5521-457-000

4.5 out of 5 stars** for plan year 2026

$51.00

Monthly Premium

Aetna Medicare Enhanced Extra (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna®

Plan ID: H5521-457-000

** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$51.00

Monthly Premium

If you have Medicare in New York, you may want to review your coverage options. Medicare Advantage plans cover services that aren’t covered by Original Medicare (Part A and Part B).

Aetna Medicare Advantage plans may cover prescription drugs and plans may offer other benefits that Original Medicare doesn’t cover.

Enrollment may be limited to certain times of the year. See why you may be able to enroll.

Compare Aetna Medicare Advantage plans today.

Speak with a licensed TZ insurance agent^*

1-800-891-6309

TTY 711, 24/7

Aetna Medicare Enhanced Extra (PPO) Basic Costs and Coverage

Learn more about the costs, benefits and coverage of Aetna Medicare Enhanced Extra (PPO) below:

Coverage	Details
Monthly plan premium	$51.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$615.00
Out-of-pocket maximum	$9,250.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$2,100.00
Primary care doctor visit	In-Network\|$0
Specialty doctor visit	Out-of-Network\|$60
Inpatient hospital care	Out-of-Network\|$500 per day, days 1-20; $0 per day, days 21-90
Urgent care	Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $115 Maximum Plan Benefit of $250,000
Emergency room visit	$115 If you are admitted to the hospital within 24 hours your cost share may be waived
Ambulance transportation	Out-of-Network\|$290

Additional Health Services and Supplies Coverage

Aetna Medicare Enhanced Extra (PPO) may cover additional health services and medical supplies. Learn more below:

Coverage	Details
Chiropractic services	In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15
Diabetes supplies, training, nutrition therapy and monitoring	Out-of-Network\|0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies\|20% for other covered diabetic supplies
Durable medical equipment (DME)	In-Network\|0% for continuous glucose monitors\|20% for all other Medicare-covered DME items
Diagnostic tests, lab and radiology services, and X-rays	Lab Services: In-Network\|$0 for Hemoglobin A1C tests\|$5 for other lab services Diagnostic Procedures: In-Network\|$0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)\|\|$45 for other diagnostic procedures and tests Imaging: In-Network\|Xray: $45\|CT Scans: $225 for CT/CAT scans; $300 for all other complex imaging\|Diagnostic Radiology other than CT Scans: $225 for CT/CAT scans; $300 for all other complex imaging\|Diagnostic Radiology Mammogram: $0
Home health care	Out-of-Network\|40%
Mental health inpatient care	In-Network: Psychiatric Hospital Services: $346 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient care	Out-of-Network\|40% for Mental Health Services- Group Sessions\|40% for Mental Health Services - Individual Sessions\|40% for Psychiatric Services - Group Sessions\|40% for Psychiatric Services - Individual Sessions
Outpatient services/surgery	Ambulatory Surgical Center: In-Network\|$0 for preventive and diagnostic colonoscopy\|$350 all other ambulatory surgical center services
Outpatient substance abuse care	Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 40%
Podiatry services	In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $45
Skilled Nursing Facility (SNF) care	In-Network\|$0 per day, days 1-20; $218 per day, days 21-100\|\|Out-of-Network\|25% per stay

Dental Benefits

Aetna Medicare Enhanced Extra (PPO) offers the following dental benefits and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.

Coverage	Details
Dental care	In-Network\|\|Preventive dental services:\|$0 for oral exams\|$0 for cleanings\|$0 for x-rays

Vision Benefits

Aetna Medicare Enhanced Extra (PPO) offers the following vision benefits. There may be provider network restrictions. You can find more information about network restrictions in the Evidence of Coverage.

Coverage	Details
Vision care	Out-of-Network\|\|Eye Exams:\|$60 for Medicare-covered eye exams\|$0 for non-Medicare covered eye exams\|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50)\|\|Eyewear:\|40% for Medicare-covered prescription eyewear\|$0 for Contacts\|$0 for Eyeglass Frames\|$0 for Eyeglass Lenses\|$0 for Eyeglass Lenses and Frames\|$0 for Upgrades\|\|$100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear.

Coverage

Details

Vision care

Out-of-Network||Eye Exams:|$60 for Medicare-covered eye exams|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50)||Eyewear:|40% for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Eyeglass Lenses and Frames|$0 for Upgrades||$100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear.

Hearing Benefits

Aetna Medicare Enhanced Extra (PPO) offers the following hearing benefits and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.

Coverage	Details
Hearing care	In-Network\|\|Hearing Exams:\|$45 for Medicare-covered hearing exams\|$0 for non-Medicare covered hearing exams\|(Maximum one non-Medicare covered hearing exam every year in or out-of-network)\|$0 for fitting/evaluation for hearing aids\|(Maximum one hearing aid fitting/evaluation every year)\|\|Hearing Aids:\|$0-$1,700 for hearing aids\|(Maximum two hearing aids every year)

Preventive Services and Health/Wellness Education Programs

Aetna Medicare Enhanced Extra (PPO) offers the following preventive services, benefits and wellness programs. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	Out-of-Network\|0% for the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines\|40% for all other preventive services covered under Original Medicare

Prescription Drug Costs and Coverage

Aetna Medicare Enhanced Extra (PPO) offers prescription drug coverage, with an annual drug deductible of $615.00 (excludes Tiers 1 and 2)

Coverage & Cost 30 day supply 60 day supply 90 day supply
Coverage	Cost 30 day supply 60 day supply 90 day supply
Annual drug deductible	$615.00 (excludes Tiers 1 and 2)
Tier 1 - Preferred Generic	Preferred retail $0.00 Standard retail $2.00 Preferred mail order $0.00 Standard mail order $2.00
Tier 2 - Generic	Preferred retail $0.00 Standard retail $12.00 Preferred mail order $0.00 Standard mail order $12.00
Annual drug deductible	$615.00 (excludes Tiers 1 and 2)
Tier 1 - Preferred Generic	Preferred retail $0.00 Standard retail $4.00 Preferred mail order $0.00 Standard mail order $4.00
Tier 2 - Generic	Preferred retail $0.00 Standard retail $24.00 Preferred mail order $0.00 Standard mail order $24.00
Annual drug deductible	$615.00 (excludes Tiers 1 and 2)
Tier 1 - Preferred Generic	Preferred retail $0.00 Standard retail $6.00 Preferred mail order $0.00 Standard mail order $6.00
Tier 2 - Generic	Preferred retail $0.00 Standard retail $36.00 Preferred mail order $0.00 Standard mail order $36.00

We can help you find out if your doctors are in a plan’s network when reviewing Aetna Medicare Advantage plans in New York. We can also help you look for plans that cover your prescription drugs.

There may be other Aetna Medicare Advantage plans available in New York. Call 1-800-891-6309 TTY 711, 24/7 to speak with a licensed TZ insurance agent^* who can help you compare plans where you live.

Plan Documents

Learn more about Aetna Medicare Enhanced Extra (PPO) by reviewing the following documents:

Links to plan documents

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