Aetna Medicare Enhanced (PPO)
Aetna Medicare · PPO · 2026 coverage
This plan ends after 2026
Ends December 31. Choose a new plan by December 7, or by the last day of February. You may also have a right to buy a Medigap policy.
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $204
- Highest of 26 plans here
- Most you pay in a year for covered care in network
- $4,900
- Higher than most plans here
- Drug deductible
- $615
- Tied for highest here
- Most you pay for covered drugs in a year
- $2,100
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 25 other plans in Santa Clara County that the same person could join.
What stands out
- Dental: plan pays up to $1,000 a year, more than most plans here
- Dental, vision and hearing extras included
Watch out for
- $204 monthly premium, highest of 26 plans here
- Up to $4,900 a year for covered care, higher than most plans here
- $1,500 for a 5-day hospital stay, higher than most plans here
- $30 for specialist visits, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$2,468$2,448 in premiums + $20 for careHighest of 26 plans here2 checkups and 2 lab tests.Uses the highest listed cost for: Lab tests.
- A busier year$2,648$2,448 in premiums + $200 for careHighest of 26 plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.Uses the highest listed cost for: Lab tests.
- A hard year$5,283$2,448 in premiums + $2,835 for careHighest of 26 plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: Lab tests, MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$30Higher than most plans here
- Urgent care$40Higher than most plans here
- Emergency room$130Not charged if you stay in the hospital within 24 hours
- Hospital stay$300 a day for days 1 to 7, then $0 for days 8 to 90Higher than most plans herePlan approval may be needed
- Lab tests$0 to $10Depends on the servicePlan approval may be needed
More care: surgery, scans, mental health, therapy, home health and more
- Outpatient surgery center$0 to $250Depends on the servicePlan approval may be needed
- Outpatient hospital care$0 to $300Depends on the service
- X-rays$0Plan approval may be needed
- MRI, CT and other scans$0 to $250Depends on the servicePlan approval may be needed
- Ground ambulance$285Higher than most plans herePlan approval may be needed
- Skilled nursing facility$10 a day for days 1 to 20, then $218 a day for days 21 to 100Plan approval may be needed
- Mental health therapy visit$40Tied for highest herePlan approval may be needed
- Psychiatrist visit$40Tied for highest herePlan approval may be needed
- Physical or speech therapy$30Highest of 22 plans here
- Occupational therapy$30Highest of 23 plans here
- Home health care$0Plan approval may be needed
- Medical equipment, like a walker or oxygen0% to 20%Depends on the servicePlan approval may be needed
- Kidney dialysis20%Plan approval may be needed
- Chemotherapy and radiation drugs0% to 20%Depends on the servicePlan approval may be needed
- Other drugs given at a clinic0% to 20%Depends on the servicePlan approval may be needed
- Heart rehab$20Higher than most plans here
- Foot doctor (podiatrist)$30Higher than most plans here
- Chiropractor$15Higher than most plans here
Seeing doctors outside the network
This plan also pays for care outside its network, at different costs.
The most you pay in a year for covered care, in and out of network together, is $8,900 (in network alone: $4,900).
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 25 other plans in Santa Clara County that the same person could join. Read the plan’s 2026 booklet (PDF)
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Add your doctors once. We’ll check them against each plan you look at.
Before you choose, call each doctor’s office and ask:
“Do you take Aetna Medicare Enhanced (PPO), plan number H5521-676, for 2026?”
What medicines cost
The most you pay for covered drugs in 2026 is $2,100. After that, covered drugs cost $0 for the rest of the year.
| Drug tier | Preferred pharmacy | Other network pharmacy |
|---|---|---|
| 1Preferred Generic | $0 | $2 |
| 2Generic | $0 | $12 |
| 3Preferred BrandAfter the deductible | 24% of the price | 24% of the price |
| 4Non-Preferred DrugAfter the deductible | 25% of the price | 25% of the price |
| 5Specialty TierAfter the deductible | 25% of the price | 25% of the price |
For a 1-month supply. The $615 drug deductible applies only to the tiers marked. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams: $0. Fillings, crowns and dentures: you pay 20% to 50%.Plan pays up to $1,000 a year.
- Vision IncludedYearly eye exam: $0. Glasses or contacts covered.Eye exams: plan pays up to $50 a year. Eyewear: plan pays up to $200 a year.
- Hearing IncludedHearing test: $0. Hearing aids covered.Hearing aids: plan pays up to $1,250 a year per ear.
- Over-the-counter items IncludedUp to $30 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes.
- Rides to care Not included
- Other extras IncludedIncludes a nurse phone line or online visits, health classes, extra help to quit smoking and wigs for hair loss from chemotherapy.
Help paying for this plan
Programs that can lower your Medicare costs if your income is limited.
Extra Help with drug costs
With full Extra Help, you’d pay $10.80 a month for the drug part of this plan’s premium instead of $22.80. The $181.20 medical part stays the same.
Extra Help also lowers what you pay for each medicine.
See who can get Extra HelpHelp with your Part B premium
A Medicare Savings Program can pay your Part B premium, and for some people more of their Medicare costs.
See who can get a Medicare Savings ProgramContact the plan
- Call about joining(833) 859-6031 · TTY 711
- Plan websitewww.aetna.com/medicare
- List of covered drugswww.aetnamedicare.com/formulary
- Find a pharmacywww.aetnamedicare.com/findpharmacy
- Full 2026 rulesRead the plan’s booklet (PDF)
From the details the plan filed with Medicare for 2026. To check whether a doctor takes this plan, call the doctor’s office, not the plan.