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Aetna Medicare Essential (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$62.00
Monthly Premium
Aetna Medicare Essential (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H5521-590
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.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Aetna Medicare Essential (PPO) - H5521-590 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$62.00
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $590 |
| Out of Pocket Max |
In-Network: $5900 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2000 |
| Primary Care Doctor Visit | $0 in-network $50% out-of-network |
| Specialty Doctor Visit | In-Network $30 Out-of-Network $50% |
| 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 | Urgent Care: Copayment for Urgent Care $40 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 | $280 in-network $280 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Essential (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 | Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 50% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 |
| 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 Equipment (DME) | In-Network 0% for continuous glucose monitors 20% for all other Medicare-covered DME items Out-of-Network 50% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network $0 for Hemoglobin A1C tests $10 for other lab services Out-of-Network 50% Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $100 for other diagnostic procedures and tests Out-of-Network 50% Imaging: Xray: $10 in-network CT Scans: $275 in-network Diagnostic Radiology other than CT Scans: $275 in-network Diagnostic Radiology Mammogram: $0 in-network 50% out-of-network |
| Home Health Care | $0 in-network 50% out-of-network |
| Mental Health Inpatient Care | Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 50% |
| Mental Health Outpatient Care | In-Network $45 for Mental Health - Group Sessions $45 for Mental Health - Individual Sessions $45 for Psychiatric Services - Group Sessions $45 for Psychiatric Services - Individual Sessions Out-of-Network 50% for Mental Health Services- Group Sessions 50% for Mental Health Services - Individual Sessions 50% for Psychiatric Services - Group Sessions 50% for Psychiatric Services - Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $330 all other ambulatory surgical center services Out-of-Network 50% |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $75 Copayment for Medicare-covered Group Sessions $75 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 50% Coinsurance for Medicare Covered Group Sessions 50% |
| Over-the-counter (OTC) Items | $75 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 | Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 50% In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $30 |
| Skilled Nursing Facility Care | $0 per day, days 1-20; $214 per day, days 21-100 in-network 50% 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 x-rays Comprehensive dental services: 20%-50% for restorative services 20% for endodontic services 20%-50% for periodontic services 50% for removeable prosthodontics 50% for fixed prosthodontics 20% - 50% for oral and maxillofacial surgery 20% - 50% for adjunctive services 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 $3,500 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
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network Eye Exams: $0 for Diabetic eye exams $30 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: 50% for Medicare-covered eye exams 50% for non-Medicare covered eye exams (Maximum one non-Medicare covered eye exam every year in or out-of-network) 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 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: $30 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 $1,000 benefit amount (allowance) per ear, every year for hearing aids (Maximum two hearing aids every year) 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
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 the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines 50% for all other preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Essential (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 |
|
| Generic |
|
| Annual Drug Deductible | $590 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $590 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|