Aetna Medicare Enhanced (PPO)
Aetna Medicare
PPOSanta Clara CountyIncludes Part DPlan year 2026
$204/momonthly premium
$4,900most you pay in-network per year
4.5overall CMS star rating
—enrollment not published
Plan-level limits
Premium, deductibles, and the most you can pay out of pocket in a year.
Combined in- and out-of-network out-of-pocket maximum$8,900
In-network out-of-pocket maximum$4,900
Plan premium, per month$181.20
Out-of-network out-of-pocket maximum$8,900
What a year on this plan would likely cost
What you pay for care
In-network costs for every service in this plan's CMS benefit filing. A copay is a fixed dollar amount; coinsurance is a percentage of the bill.
Hospital stays
Inpatient hospital stay
Days 1–7$300 per day
Days 8–90$0 per day
Inpatient psychiatric stay
Days 1–7$300 per day
Days 8–90$0 per day
Skilled nursing facility stay
Days 1–20$10 per day
Days 21–100$218 per day
Doctor visits
Primary care visit
$0
You pay nothing
Specialist visit
$30
Copay
Telehealth visit
20%
Coinsurance — your share of the bill
Other health care professional
$0–$30
Copay, depends on the service
Chiropractic care (Medicare-covered)
$15
Copay
Podiatry (Medicare-covered)
$30
Copay
Emergency and urgent care
Emergency room visit
$130
Copay
Urgent care visit
$40
Copay
Emergency care outside the U.S.
$130
Copay
Up to $250,000
Urgent care outside the U.S.
$130
Copay
Emergency transportation outside the U.S.
$285
Copay
Mental health and substance use
Individual therapy session
$40
Copay
Group therapy session
$40
Copay
Opioid treatment program
$40
Copay
Partial hospitalization program
$70–$145
Copay, depends on the service
Prior authorization required
Therapy and rehabilitation
Occupational therapy
$30
Copay
Physical and speech therapy
$30
Copay
Cardiac rehabilitation
$20
Copay
Intensive cardiac rehabilitation
$20
Copay
Pulmonary rehabilitation
$15
Copay
Supervised exercise therapy for peripheral artery disease
$20
Copay
Tests, labs and imaging
Lab services
$0–$10
Copay, depends on the service
Diagnostic tests
$0
You pay nothing
Diagnostic procedures
$0
You pay nothing
Diagnostic radiology (MRI, CT, PET)
$0–$250
Copay, depends on the service
Therapeutic radiology
20%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
$0–$300
Copay, depends on the service
Ambulatory surgical center
$0–$250
Copay, depends on the service
Observation services
$300
Copay
Blood services
$0
You pay nothing
Home health care
Home health visit
$0
You pay nothing
Medical equipment and supplies
Durable medical equipment
0–20%
Coinsurance, depends on the service
Medical supplies
0–20%
Coinsurance, depends on the service
Prosthetic devices
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
20%
Coinsurance — your share of the bill
Part B drugs
Part B drugs
0–20%
Coinsurance, depends on the service
Chemotherapy drugs
0–20%
Coinsurance, depends on the service
Part B insulin
$35
Copay
Vision
Eye exam (Medicare-covered)
$0
You pay nothing
Routine eye exam
$0
You pay nothing
Up to $50 per year
Other eye exams
$0
You pay nothing
Eyewear after cataract surgery (Medicare-covered)
$0
You pay nothing
Eyeglasses (lenses and frames)
$0
You pay nothing
Eyeglass lenses
$0
You pay nothing
Eyeglass frames
$0
You pay nothing
Contact lenses
$0
You pay nothing
Eyewear upgrades
$0
You pay nothing
Eyewear allowance
Up to $200 per year
Allowance
Hearing
Hearing exam (Medicare-covered)
$0
You pay nothing
Routine hearing exam
$0
You pay nothing
Hearing aid fitting and evaluation
$0
You pay nothing
Prescription hearing aids
$0
You pay nothing
Up to $1,250 per year, per ear
Extra benefits
Over-the-counter items
$0
You pay nothing
Up to $30 every three months
Annual wellness exam and screening mammography
$0
You pay nothing
Additional gFOBT and FIT not covered by Medicare
$0
You pay nothing
Out of network
What you pay when a provider is not in the plan's network. Out-of-network costs stop at $8,900 a year, $8,900 combined with in-network.
Doctor visits
Primary care visit
$15
Copay
Chiropractic care (Medicare-covered)
45%
Coinsurance — your share of the bill
Specialist visit
$55
Copay
Podiatry (Medicare-covered)
45%
Coinsurance — your share of the bill
Other health care professional
$0–$55
Copay, depends on the service
Mental health and substance use
Partial hospitalization program
45%
Coinsurance — your share of the bill
Intensive outpatient program
45%
Coinsurance — your share of the bill
Individual therapy session
45%
Coinsurance — your share of the bill
Group therapy session
45%
Coinsurance — your share of the bill
Psychiatrist visit, individual
45%
Coinsurance — your share of the bill
Psychiatrist visit, group
45%
Coinsurance — your share of the bill
Opioid treatment program
45%
Coinsurance — your share of the bill
Substance use treatment, individual
45%
Coinsurance — your share of the bill
Substance use treatment, group
45%
Coinsurance — your share of the bill
Therapy and rehabilitation
Cardiac rehabilitation
45%
Coinsurance — your share of the bill
Intensive cardiac rehabilitation
45%
Coinsurance — your share of the bill
Pulmonary rehabilitation
45%
Coinsurance — your share of the bill
Supervised exercise therapy for peripheral artery disease
45%
Coinsurance — your share of the bill
Occupational therapy
45%
Coinsurance — your share of the bill
Physical and speech therapy
45%
Coinsurance — your share of the bill
Tests, labs and imaging
Diagnostic procedures and tests
45%
Coinsurance — your share of the bill
Lab services
$55
Copay
Diagnostic radiology (MRI, CT, PET)
45%
Coinsurance — your share of the bill
Therapeutic radiology
45%
Coinsurance — your share of the bill
X-rays
45%
Coinsurance — your share of the bill
Outpatient hospital and surgery
Outpatient hospital services
45%
Coinsurance — your share of the bill
Observation services
45%
Coinsurance — your share of the bill
Ambulatory surgical center
45%
Coinsurance — your share of the bill
Blood services
45%
Coinsurance — your share of the bill
Home health care
Home health visit
45%
Coinsurance — your share of the bill
Ambulance
Ground ambulance
$285
Copay
Air ambulance
20%
Coinsurance — your share of the bill
Medical equipment and supplies
Durable medical equipment
45%
Coinsurance — your share of the bill
Prosthetic devices
45%
Coinsurance — your share of the bill
Medical supplies
45%
Coinsurance — your share of the bill
Diabetes monitoring supplies
0–20%
Coinsurance, depends on the service
Therapeutic shoes or inserts for diabetes
20%
Coinsurance — your share of the bill
Dialysis
Dialysis
50%
Coinsurance — your share of the bill
Part B drugs
Part B insulin
$35
Copay
Chemotherapy drugs
45%
Coinsurance — your share of the bill
Other Part B drugs
45%
Coinsurance — your share of the bill
Preventive and wellness
Medicare-covered preventive services
0–45%
Coinsurance, depends on the service
Annual physical exam
45%
Coinsurance — your share of the bill
Health Education
$0
You pay nothing
Additional Sessions of Smoking and Tobacco Cessation Counseling
45%
Coinsurance — your share of the bill
Fitness Benefit
$0
You pay nothing
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)
$0
You pay nothing
Wigs for Hair Loss Related to Chemotherapy
$0
You pay nothing
Kidney disease education
45%
Coinsurance — your share of the bill
Diabetes screening
45%
Coinsurance — your share of the bill
Digital rectal exam
45%
Coinsurance — your share of the bill
Electrocardiogram (EKG)
$0
You pay nothing
Glaucoma screening
$0
You pay nothing
Vision
Eye exam (Medicare-covered)
45%
Coinsurance — your share of the bill
Routine eye exam
0%
You pay nothing
Other eye exams
45%
Coinsurance — your share of the bill
Eyewear after cataract surgery (Medicare-covered)
45%
Coinsurance — your share of the bill
Eyeglasses (lenses and frames)
$0
You pay nothing
Contact lenses
$0
You pay nothing
Eyeglass lenses
$0
You pay nothing
Eyeglass frames
$0
You pay nothing
Eyewear upgrades
$0
You pay nothing
Hearing
Hearing exam (Medicare-covered)
45%
Coinsurance — your share of the bill
Routine hearing exam
45%
Coinsurance — your share of the bill
Hearing aid fitting and evaluation
45%
Coinsurance — your share of the bill
Prescription hearing aids
$0
You pay nothing
Extra benefits
Over-the-counter items
$0
You pay nothing
Annual wellness exam and screening mammography
45%
Coinsurance — your share of the bill
Additional gFOBT and FIT not covered by Medicare
45%
Coinsurance — your share of the bill
Dental
Dental services (Medicare-covered)
45%
Coinsurance — your share of the bill
Oral exams
50%
Coinsurance — your share of the bill
Dental X-rays
50%
Coinsurance — your share of the bill
Cleanings
50%
Coinsurance — your share of the bill
Restorative services (fillings)
50–70%
Coinsurance, depends on the service
Endodontics (root canals)
50%
Coinsurance — your share of the bill
Periodontics (gum treatment)
50–70%
Coinsurance, depends on the service
Removable prosthodontics (dentures)
70%
Coinsurance — your share of the bill
Fixed prosthodontics (crowns, bridges)
70%
Coinsurance — your share of the bill
Oral and maxillofacial surgery
50–70%
Coinsurance, depends on the service
Adjunctive general dental services
50–70%
Coinsurance, depends on the service
Extra benefits beyond Original Medicare
Supplemental benefits this plan filed with CMS, with the cap and period exactly as filed.
No supplemental benefits are filed for this plan.
Not offered by this plan
Health EducationIn-Home Safety AssessmentPersonal Emergency Response System (PERS)Medical Nutrition Therapy (MNT)Post discharge In-Home Medication ReconciliationRe-admission PreventionWigs for Hair Loss Related to ChemotherapyWeight Management ProgramsAlternative TherapiesTherapeutic MassageAdult Day Health ServicesNutritional/Dietary BenefitHome-Based Palliative CareIn-Home Support ServicesSupport for Caregivers of EnrolleesAdditional Sessions of Smoking and Tobacco Cessation CounselingFitness BenefitEnhanced Disease ManagementTelemonitoring ServicesRemote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Home and Bathroom Safety Devices and ModificationsCounseling Services
Prescription drugs (Part D)
$615 annual drug deductible · 5 formulary tiers · mail order available. Costs shown for a 30-day supply.
Before the deductible
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $2 copay | No copay | — | Waived |
| 2. Generic | No copay | $12 copay | No copay | — | Waived |
Initial coverage
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | $2 copay | No copay | — | Waived |
| 2. Generic | No copay | $12 copay | No copay | — | Waived |
| 3. Preferred Brand | 24% coinsurance | 24% coinsurance | 24% coinsurance | $35 | Applies |
| 4. Non-Preferred Drug | 25% coinsurance | 25% coinsurance | 25% coinsurance | $35 | Applies |
| 5. Specialty Tier specialty | 25% coinsurance | 25% coinsurance | 25% coinsurance | $35 | Applies |
Catastrophic (after the out-of-pocket threshold)
| Tier | Preferred retail | Standard retail | Mail order | Insulin | Deductible |
|---|---|---|---|---|---|
| 1. Preferred Generic | No copay | No copay | No copay | — | Waived |
| 2. Generic | No copay | No copay | No copay | — | Waived |
| 3. Preferred Brand | No copay | No copay | No copay | $35 | Applies |
| 4. Non-Preferred Drug | No copay | No copay | No copay | $35 | Applies |
| 5. Specialty Tier specialty | No copay | No copay | No copay | $35 | Applies |
Out-of-pocket threshold for the catastrophic phase: $2,100.
Is my medicine on this plan’s list?
Pharmacies near you in this plan's network
From the plan's filed Part D pharmacy network, matched to geocoded pharmacy locations. Preferred pharmacies come first: they carry the lower copay column in the tier table above. The ZIP you enter stays in this browser.
CMS star ratings
Star ratings are set by CMS for the whole contract, so every plan under this contract shares them.
4.5 out of 5Overall rating
4.5 out of 5Health services (Part C)
5 out of 5Drug plan (Part D)
Staying healthy: screenings, tests and vaccines
4- Annual flu vaccine3
- Breast cancer screening4
- Colorectal cancer screening4
- Monitoring physical activity3
- Improving or maintaining mental health5
- Improving or maintaining physical health5
Managing chronic (long-term) conditions
4- Readmissions4
- Kidney health3
- Blood pressure4
- Reducing falls1
- Statin therapy3
- Pain assessment4
- Bladder control3
- Medication review5
- Diabetes eye exam4
- Transitions of care3
- Diabetes blood sugar5
- Osteoporosis management3
- Followup after emergency department visit4
- Medication reconciliation5
- Special needs plan SNP care management3
Member experience with the health plan
4- Customer service3
- Care coordination5
- Healthcare quality5
- Health plan rating4
- Getting needed care4
- Getting appointments4
Member complaints and changes in the plan's performance
5- Complaints5
- Members leaving5
- Quality improvement4
Health plan customer service
4- Call center4
- Timely decisions3
- Appeals decisions4
Drug plan customer service
5- Call center foreign language interpreter and TTY availability5
Drug plan complaints and changes
5- Complaints5
- Members leaving5
- Quality improvement5
Member experience with the drug plan
4- Drug plan rating4
- Prescription drugs4
Drug safety and accuracy of drug pricing
4- Price accuracy5
- Statin diabetes3
- Medication therapy management comprehensive medication review completion4
- Medication adherence for diabetes medications4
- Medication adherence for hypertension RAS antagonists s4
- Medication adherence for cholesterol statins4
Why members leave this contract
Service area and network
Service area not published.
Doctor directory
22,788 providers are named in Aetna Medicare’s directory for this plan, dated Jun 26, 2026.
A doctor named there is listed. A doctor missing from it is unknown, never out of network: carrier directories are partial and change monthly. Open the carrier directory
Medicare Advantage regionCalifornia
Ask about this plan
A question box grounded in this plan's filed benefits, drug list, and pharmacy network. It reads the same records shown on this page and says so when something is not filed.
Answers come from this plan’s filed benefits, drug list, and pharmacy network. They are not enrollment advice; the Evidence of Coverage is the final word.