Aetna Medicare Value Plus (PPO)
Aetna Medicare Value Plus (PPO) H5521-467 Plan Details
Aetna Medicare Value Plus (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-467
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.
$9.70
Monthly Premium
Aetna Medicare Value Plus (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-467
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 Medicare Value Plus (PPO) H5521-467 Plan Details
Aetna Medicare Value Plus (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-467
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.
$9.70
Monthly Premium
Alabama Counties Served
Noxubee
Morgan
Marshall
Winston
Franklin
Lawrence
Marion
Colbert
Dade
Limestone
Lauderdale
Madison
Jackson
De Kalb
Tallapoosa
Elmore
Chilton
Perry
Crenshaw
Autauga
Macon
Lowndes
Barbour
Pike
Coffee
Bullock
Washington
Butler
Dale
Montgomery
Henry
Houston
Covington
Wilcox
Russell
Chambers
Geneva
Escambia
Clarke
Baldwin
Mobile
Marengo
Choctaw
Dallas
Lee
Randolph
Saint Clair
Coosa
Tuscaloosa
Jefferson
Walker
Shelby
Calhoun
Cullman
Talladega
Blount
Bibb
Clay
Etowah
Lamar
Fayette
Greene
Hale
Pickens
Cherokee
Cleburne
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $590 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | $0 in-network|$5 out-of-network |
| Specialty Doctor Visit | In-Network|$0 for services provided in a nursing home|$15 for services provided outside a nursing home||Out-of-Network|$20 |
| Inpatient Hospital Care | $380 per day, days 1-7; $0 per day, days 8-90 in-network|50% per stay out-of-network |
| Urgent Care | Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110 |
| Emergency Room Visit | $110 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance Transportation | $280 in-network|$280 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Value Plus (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 $15 Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 20% |
| 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|20%||Out-of-Network|25% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network|$0 ||Out-of-Network|$10 Diagnostic Procedures: In-Network|$0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)||$0 for services provided by your primary care physician in their office|$95 for services performed by a provider other than your primary care physician||Out-of-Network|35% Imaging: Xray: $0 for services provided by your primary care physician in their office in-network; $60 for services performed by a provider other than your primary care physician in-network|40% out-of-network|CT Scans: $300 in-network|Diagnostic Radiology other than CT Scans: $300 in-network|Diagnostic Radiology Mammogram: $0 in-network|35% out-of-network |
| Home Health Care | $0 in-network|35% out-of-network |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $678 per day for days 1 to 3 $0 per day for days 4 to 90 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 40% |
| 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||Out-of-Network|35% for Mental Health Services- Group Sessions|35% for Mental Health Services - Individual Sessions|35% for Psychiatric Services: Group Sessions|35% for Psychiatric Services: Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$280 all other ambulatory surgical center services||Out-of-Network|$295 |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 35% Coinsurance for Medicare Covered Group Sessions 35% |
| Over-the-counter (OTC) Items | Over-the-Counter (OTC) Wallet with a $60 quarterly benefit amount (allowance) on the Extra Benefits Card to purchase approved over-the-counter (OTC) health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store, online, or by phone. Unused benefit amounts do not rollover. |
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $15 Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 35% |
| Skilled Nursing Facility Care | $0 per day, days 1-20 $214 per day, days 21-100 in-network|35% 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:|20% for oral exams|20% for cleanings|20% for fluoride treatments|20% for x-rays|20% for other diagnostic dental services|20% for other preventive dental services||Comprehensive dental services:|20% for restorative services|20% for endodontic services|20% for periodontic services|20% for removeable prosthodontics|20% for fixed prosthodontics|20% for oral and maxillofacial surgery|20% for adjunctive services||$2,500 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 Diabetic eye exams|$15 for all other 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:|35% for Medicare-covered eye exams|35% for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|35% 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 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:|$15 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:|35% for Medicare-covered hearing exams|35% 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 Value Plus (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $590 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
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|---|---|
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Coverage & Cost
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| Annual Drug Deductible | $590 (excludes Tiers 1 and 2) |
| Preferred Generic |
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| Generic |
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| Annual Drug Deductible | $590 (excludes Tiers 1 and 2) |
| Preferred Generic |
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| Generic |
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| Annual Drug Deductible | $590 (excludes Tiers 1 and 2) |
| Preferred Generic |
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| Generic |
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