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Aetna Medicare Enhanced (PPO) - H5521-607-000

4.5 out of 5 stars** for plan year 2026

$72.00

Monthly Premium

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

Plan ID: H5521-607-000

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

$72.00

Monthly Premium

If you have Medicare in Michigan, 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 (PPO) Basic Costs and Coverage

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

Coverage	Details
Monthly plan premium	$72.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$615.00
Out-of-pocket maximum	$5,900.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$2,100.00
Primary care doctor visit	Out-of-Network\|50%
Specialty doctor visit	In-Network\|$40
Inpatient hospital care	In-Network\|$325 per day, days 1-7; $0 per day, days 8-90\|\|Out-of-Network\|50% per stay
Urgent care	Urgent Care: Copayment for Urgent Care $35 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $130 Maximum Plan Benefit of $250,000
Emergency room visit	$130 If you are admitted to the hospital within 24 hours your cost share may be waived
Ambulance transportation	In-Network\|$250

Additional Health Services and Supplies Coverage

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

Coverage	Details
Chiropractic services	Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 50%
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 Diagnostic Procedures: In-Network\|$0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)\|\|$75 for other diagnostic procedures and tests Imaging: In-Network\|Xray: $0\|CT Scans: $290\|Diagnostic Radiology other than CT Scans: $290\|Diagnostic Radiology Mammogram: $0
Home health care	Out-of-Network\|50%
Mental health inpatient care	Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 50%
Mental health outpatient care	In-Network\|$40 for Mental Health - Group Sessions\|$40 for Mental Health - 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\|$275 all other ambulatory surgical center services
Outpatient substance abuse care	In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items	CVS Over-the-Counter (OTC) Wallet with a $60 quarterly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions.
Podiatry services	Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 50%
Skilled Nursing Facility (SNF) care	Out-of-Network\|50% per stay

Dental Benefits

Aetna Medicare Enhanced (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	Out-of-Network\|\|Preventive dental services:\|50% for oral exams\|50% for cleanings\|50% for x-rays\|\|Comprehensive dental services:\|50% - 70% for restorative services\|50% for endodontic services\|50% - 70% for periodontic services\|70% for removeable prosthodontics\|70% for fixed prosthodontics\|50% - 70% for oral and maxillofacial surgery\|50% - 70% for adjunctive services\|\|$2,500 benefit amount (allowance) every year in and out-of-network for covered comprehensive dental services. Frequencies and medical necessity requirements vary by covered dental service. Covered preventive dental services do not count towards your annual benefit amount. See EOC for additional details on exclusions and limitations.

Coverage

Details

Dental care

Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% for x-rays||Comprehensive dental services:|50% - 70% for restorative services|50% for endodontic services|50% - 70% for periodontic services|70% for removeable prosthodontics|70% for fixed prosthodontics|50% - 70% for oral and maxillofacial surgery|50% - 70% for adjunctive services||$2,500 benefit amount (allowance) every year in and out-of-network for covered comprehensive dental services. Frequencies and medical necessity requirements vary by covered dental service. Covered preventive dental services do not count towards your annual benefit amount. See EOC for additional details on exclusions and limitations.

Vision Benefits

Aetna Medicare Enhanced (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:\|50% 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:\|50% 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\|\|$250 annual benefit amount (allowance) for non-Medicare covered prescription eyewear.

Coverage

Details

Vision care

Out-of-Network||Eye Exams:|50% 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:|50% 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||$250 annual benefit amount (allowance) for non-Medicare covered prescription eyewear.

Hearing Benefits

Aetna Medicare Enhanced (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	Out-of-Network:\|\|Hearing Exams:\|50% for Medicare-covered hearing exams\|50% for non-Medicare covered hearing exam every year in or out-of-network\|\|Hearing Aids: You must purchase hearing aids through NationsHearing

Preventive Services and Health/Wellness Education Programs

Aetna Medicare Enhanced (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\|50% for all other preventive services covered under Original Medicare

Prescription Drug Costs and Coverage

Aetna Medicare Enhanced (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 Michigan. We can also help you look for plans that cover your prescription drugs.

There may be other Aetna Medicare Advantage plans available in Michigan. 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 (PPO) by reviewing the following documents:

Links to plan documents

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