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Aetna Medicare Explorer Premier (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.
$66.00
Monthly Premium
Aetna Medicare Explorer Premier (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H5521-013
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 Explorer Premier (PPO) - H5521-013 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$66.00
Monthly Premium
Connecticut Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $590 |
| Out of Pocket Max |
In-Network: $6750 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2000 |
| Primary Care Doctor Visit | $5 in-network $40% out-of-network |
| Specialty Doctor Visit | In-Network $0 for services provided in a nursing home $45 for services provided outside a nursing home Out-of-Network $40% |
| Inpatient Hospital Care | $395 per day, days 1-6; $0 per day, days 7-90 in-network 40% per stay out-of-network |
| Urgent Care | Urgent Care: Copayment for Urgent Care $45 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $125 |
| Emergency Room Visit | $125 If you are admitted to the hospital within 0 hours your cost share may be waived |
| Ambulance Transportation | $300 in-network $300 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Explorer Premier (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: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 40% |
| 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 40% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network $0 Out-of-Network 40% Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $45 for other diagnostic procedures and tests Out-of-Network 40% Imaging: Xray: $20 in-network CT Scans: $150 for services performed at a non-hospital facility in-network; $200 for services performed at a hospital facility in-network Diagnostic Radiology other than CT Scans: $150 for services performed at a non-hospital facility in-network; $200 for services performed at a hospital facility in-network Diagnostic Radiology Mammogram: $0 in-network 40% out-of-network |
| Home Health Care | $0 in-network 40% out-of-network |
| Mental Health Inpatient Care | 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 40% for Mental Health Services- Group Sessions 40% for Mental Health Services - Individual Sessions 40% for Psychiatric Services - Group Sessions 40% for Psychiatric Services - Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $225 all other ambulatory surgical center services Out-of-Network 40% |
| Outpatient Substance Abuse Care | Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 40% In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | $45 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: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $45 Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 40% |
| Skilled Nursing Facility Care | $10 per day, days 1-20; $214 per day, days 21-100 in-network 40% 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 Out-of-Network Preventive dental services: 50% for oral exams 50% for cleanings 50% for x-rays Frequencies vary by covered dental service. |
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 $45 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: 40% for Medicare-covered eye exams 40% for non-Medicare covered eye exams (Maximum one non-Medicare covered eye exam every year in or out-of-network) Eyewear: 40% 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 $200 benefit amount (allowance) reimbursement 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: $45 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-$1,700 for hearing aids (Maximum two hearing aids every year) Out-of-Network: Hearing Exams: 40% for Medicare-covered hearing exams 40% 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 40% for all other preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Explorer Premier (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 |
|