Skip to main content

Aetna Medicare Enhanced Select (PPO)

Aetna Inc.
Aetna Medicare Enhanced Select (PPO) H5521-386 Plan Details
4.5 out of 5 stars

Aetna Medicare Enhanced Select (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-386

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$166.00
Monthly Premium

Aetna Medicare Enhanced Select (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-386

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Aetna Inc.
Aetna Medicare Enhanced Select (PPO) H5521-386 Plan Details
4.5 out of 5 stars

Aetna Medicare Enhanced Select (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-386

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

$166.00
Monthly Premium

Michigan Counties Served

Kalamazoo Van Buren Saint Joseph Allegan Berrien Cass Hillsdale Lenawee Muskegon Ottawa Wexford Antrim Kalkaska Barry Shiawassee Kent Montcalm Eaton Calhoun Saint Clair Macomb Lapeer Oakland Sanilac Tuscola Washtenaw Wayne Livingston Monroe Huron Genesee Saginaw Gratiot Arenac Clare Bay Gladwin Ogemaw Oscoda Montmorency Roscommon Osceola Crawford Iosco Ingham Clinton Ionia Jackson Mecosta Branch Newaygo Lake Oceana Mason Benzie Emmet Manistee Missaukee Grand Traverse Leelanau Charlevoix Otsego

Wisconsin Counties Served

Waukesha Washington Sheboygan Ozaukee Trempealeau Adams Marquette Dane Lafayette Milwaukee Walworth Racine Kenosha Waushara Rock Green Iowa Columbia Monroe Vernon La Crosse

Indiana Counties Served

Madison Hamilton Boone Hendricks Hancock Marion Johnson Morgan Shelby Lake Porter Pulaski Newton Jasper La Porte Starke Delaware Clinton Tipton Montgomery Tippecanoe Putnam Rush Grant Carroll Henry Bartholomew Howard Owen Fayette Parke Monroe Decatur Brown Franklin Kosciusko St Joseph Marshall Lagrange Adams Fulton Elkhart Noble Steuben Whitley Huntington Wabash Allen Jay Dekalb Wells Miami Cass Blackford White Ohio Ripley Union Dearborn Harrison Washington Randolph Switzerland Jennings Jefferson Clark Floyd Scott Clay Jackson Orange Lawrence Crawford Greene Perry Martin Dubois Sullivan Daviess Knox Spencer Warrick Pike Posey Gibson Vanderburgh Vigo Vermillion Warren Fountain Benton

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $590
Out of Pocket Max In-Network: $1500
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
$0 in-network|0% out-of-network
Specialty Doctor Visit
In-Network|$0||Out-of-Network|0%
Inpatient Hospital Care
$200 per day, days 1-7; $0 per day, days 8-90 in-network|$200 per day, days 1-7; $0 per day, days 8-90 out-of-network
Urgent Care
Copayment for Urgent Care $0

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $125
Maximum Plan Benefit of $100,000
Emergency Room Visit
$125 If you are admitted to the hospital within 0 hours your cost share may be waived
Ambulance Transportation
$275 in-network|$275 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Enhanced Select (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:
Copayment for Medicare-covered Chiropractic Services $0
Out-of-Network:

Medicare Covered Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $0
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|0% for OneTouch/LifeScan diabetic supplies|20% for other covered diabetic supplies||Out-of-Network|0% for OneTouch/LifeScan diabetic supplies|20% for other covered diabetic supplies
Durable Medical Eqipment (DME)
In-Network|0%||Out-of-Network|0%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0 ||Out-of-Network|0%
Diagnostic Procedures: In-Network|$0||Out-of-Network|0%
Imaging: Xray: $0 in-network|CT Scans: $0 in-network|Diagnostic Radiology other than CT Scans: $0 in-network|Diagnostic Radiology Mammogram: $0 in-network|0% out-of-network
Home Health Care
$0 in-network|0% out-of-network
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$200 per day for days 1 to 7
$0 per day for days 8 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Out-of-Network:

Psychiatric Hospital Services:
$200 per day for days 1 to 7
$0 per day for days 8 to 90
Mental Health Outpatient Care
In-Network|$0 for Mental Health:
Group Sessions|$0 for Mental Health:
Individual Sessions|$0 for Psychiatric Services:
Group Sessions|$0 for Psychiatric Services:
Individual Sessions||Out-of-Network|0% for Mental Health Services- Group Sessions|0% for Mental Health Services - Individual Sessions|0% for Psychiatric Services:
Group Sessions|0% for Psychiatric Services:
Individual Sessions
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$0 all other ambulatory surgical center services||Out-of-Network|0%
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $0
Copayment for Medicare-covered Group Sessions $0
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Out-of-Network:

Medicare Covered Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $0
Copayment for Medicare Covered Group Sessions $0
Over-the-counter (OTC) Items
$30 quarterly benefit amount (allowance) to purchase approved over-the-counter (OTC) health and wellness products. Approved items can be purchased online, in store, or by phone. Unused benefit amounts do not rollover.
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $0
Out-of-Network:

Medicare Covered Podiatry Services:
Copayment for Medicare Covered Podiatry Services $0
Skilled Nursing Facility Care
$0 per stay in-network|0% per stay out-of-network

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
In-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for fluoride treatment|$0 for x-rays|$0 for other diagnostic dental services|$0 for other preventive dental services||Comprehensive dental services:|$0 for restorative services|$0 for endodontic services|$0 for periodontic services|$0 for removeable prosthodontics|$0 for fixed prosthodontics|$0 for oral and maxillofacial surgery|$0 for adjunctive services||Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% for fluoride treatments|50% for x-rays|50% for other diagnostic dental services|50% for other preventive dental services||Comprehensive dental services:|50% for restorative services|50% for endodontic services|50% for periodontic services|50% for removeable prosthodontics|50% for fixed prosthodontics|50% for oral and maxillofacial surgery|50% for adjunctive services||$1,500 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services. Medical necessity requirements vary by covered dental service.||ADA recognized dental services are covered up to the benefit amount excluding implants and related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits
In-Network||Eye Exams:|$0 for Medicare-covered eye exams|$0 for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||Out-of-Network||Eye Exams:|0% for Medicare-covered eye exams|0% for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|0% 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||$175 benefit amount (allowance) every year for non-Medicare covered prescription eyewear.

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
In-Network||Hearing Exams:|$0 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 for hearing aids|$500 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)||Out-of-Network:||Hearing Exams:|0% for Medicare-covered hearing exams|0% 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

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network|$0 copay for all preventive services covered under Original Medicare||Out-of-Network|0% for all preventive services covered under Original Medicare

Prescription Drug Costs and Coverage

The Aetna Medicare Enhanced Select (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $590 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $2.00
  • Standard mail order $2.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $12.00
  • Standard mail order $12.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $4.00
  • Standard mail order $4.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $24.00
  • Standard mail order $24.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $6.00
  • Standard mail order $6.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $36.00
  • Standard mail order $36.00
  • Preferred cost-share retail $0.00
Back to Plans