Want to learn more about Medicare?
We can help. Subscribe to our email list for the latest Medicare news and information.
Allina Health 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.
$106.00
Monthly Premium
Allina Health Aetna Medicare Signature (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H3219-013
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 Allina Health Aetna Medicare Signature (PPO) - H3219-013 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$106.00
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $250 |
| Out of Pocket Max |
In-Network: $3800 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 | $325 per stay in-network 50% per stay out-of-network |
| Urgent Care | Urgent Care: Copayment for Urgent Care $35 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $140 |
| Emergency Room Visit | $140 If you are admitted to the hospital within 0 hours your cost share may be waived |
| Ambulance Transportation | $350 in-network $350 out-of-network |
Health Care Services and Medical Supplies
Allina Health 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 | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $20 Copayment for Routine Care $20
Out-of-Network: Medicare Covered Chiropractic Services: Copayment 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 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 Out-of-Network $25 Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $25 for other diagnostic procedures and tests Out-of-Network 50% Imaging: Xray: $15 in-network $25 out-of-network CT Scans: $100 in-network Diagnostic Radiology other than CT Scans: $100 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 $30 for Mental Health - Group Sessions $30 for Mental Health - Individual Sessions $30 for Psychiatric Services - Group Sessions $30 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 $200 all other ambulatory surgical center services Out-of-Network $350 |
| Outpatient Substance Abuse Care | Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $40 Copayment for Medicare Covered Group Sessions $40 In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $30 Copayment for Medicare-covered Group Sessions $30 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | $60 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 $30 Copayment for Routine Foot Care $30
Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $40 Non-Medicare Covered Podiatry Services: Copayment for Non-Medicare Covered Podiatry Services $40 |
| Skilled Nursing Facility Care | $10 per day, days 1-20; $214 per day, days 21-38; $0 per day, days 39-100 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 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 $1,250 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services. 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 $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 $40 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 $200 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 Allina Health Aetna Medicare Signature (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $250 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $250 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $250 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $250 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|