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Aetna Medicare Signature (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.
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Monthly Premium
Aetna Medicare Signature (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H5521-360
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 Signature (PPO) - H5521-360 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
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Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $5500 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $8000 |
| Primary Care Doctor Visit | $0 in-network | $25 out-of-network |
| Specialty Doctor Visit | $25 in-network | $50 out-of-network |
| Inpatient Hospital Care | $356 per day, days 1-8; $0 per day, days 9-90 in-network | 40% per stay out-of-network |
| Urgent Care | Urgent Care: Copayment for Urgent Care $25.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $120.00 Maximum Plan Benefit of $250000.00 |
| Emergency Room Visit | $120 If you are admitted to the hospital within 24 hours your cost share may be waived, for more information see the Evidence of Coverage |
| Ambulance Transportation | $285 in-network | $285 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Signature (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: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 50% Chiropractic Services: Coinsurance for Non-Medicare Covered Chiropractic Services 50% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $20.00 Copayment for Routine Care $20.00
|
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | 0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies. |
| Durable Medical Equipment (DME) | 20% in-network | 35% out-of-network |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: Lab Services: $0 for services provided by your primary care physician in their office in-network; $15 for services performed by a provider other than your primary care physician| 40% out-of-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $0 for services provided by your primary care physician in their office in-network; $95 for services performed by a provider other than your primary care physician| 40% out-of-network, for more information see Evidence of Coverage Imaging: Xray: $0 for services provided by your primary care physician in their office in-network; $35 for services performed by a provider other than your primary care physician in-network | CT Scans: $225 in-network | Diagnostic Radiology other than CT Scans: $225 in-network | Diagnostic Radiology Mammogram: $0 in-network | 40% out-of-network, for more information see Evidence of Coverage |
| Home Health Care | $0 in-network | 40% out-of-network |
| Mental Health Inpatient Care | Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 40% |
| Mental Health Outpatient Care | Mental Health - Group Sessions: $40 in-network| Mental Health - Individual Sessions: $40 in-network| 40% out-of-network, for more information see Evidence of Coverage |Psychiatric Services - Group Sessions: $30 in-network| Psychiatric Services - Individual Sessions: $30 in-network| 40% out-of-network, for more information see Evidence of Coverage |
| Outpatient Services / Surgery | Ambulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $275 All other in network ASC services | 40% out-of-network, for more information see Evidence of Coverage |
| Outpatient Substance Abuse Care | Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual or Group Sessions 40% In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40.00 Copayment for Medicare-covered Group Sessions $40.00 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | In Network: |Over-the-counter (OTC) items:|$90 quarterly amount (allowance) to purchase approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers and more. Approved items can be purchased online, in store, or by phone. |Be sure to use the full benefit amount quarterly, because any unused amount will not rollover.|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit, for more information see Evidence of Coverage |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $25.00 Copayment for Routine Foot Care $25.00
Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 40% Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 40% |
| Skilled Nursing Facility Care | $0 per day, days 1-20; $203 per day, days 21-100 in-network| 40% per stay out-of-network, for more information see Evidence of Coverage |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |Out Of Network Dental Coverage|Preventive dental services:| $0 copay |Comprehensive dental services:| $0 copay |$2,200 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$25|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Copayment for Medicare Covered Benefits $0|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Out-of-Network:|Eye Exams:|Coinsurance for Medicare-Covered Benefits 40%|Coinsurance for Routine Eye Exams 40%|Eyewear:|Coinsurance for Medicare-Covered Benefits 40%|Copayment for Non-Medicare covered Benefits $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $260 every year. See the Evidence of Coverage |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $25|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year) |Out-of-Network:|Coinsurance for Medicare Covered Hearing Exams 40%|Coinsurance for Non-Medicare Covered Hearing Exams 40% |Member must purchase hearing aids through NationsHearing|$500 per ear every year, for more information see the Evidence of Coverage |
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 | $0 copay for all preventive services covered under Original Medicare at zero cost sharing |