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Aetna Medicare Signature Extra (PPO)
CMS Plan Rating
Contract ID
★★★★
★
H5521-704-000
Monthly premium
$0.00
Medical deductible
$0
Rx deductible
$615
Part B Giveback
N/A
Aetna Medicare Signature Extra (PPO)
CMS Plan Rating
Contract ID
★★★★
★
H5521-704-000
Monthly Premium
$0.00
Medical deductible
$0
Rx deductible
$615
Medicare Part B Giveback
N/A
Medicare Advantage, also known as Medicare Part C, is a health plan option that provides Medicare Part A and Part B coverage. Medicare Advantage plans are offered by private insurance companies that are approved by Medicare. These plans provide benefits similar to Original Medicare Part A and Part B, but often include additional benefits such as dental, hearing and vision.
Medical benefits (In-network)
What you pay
Primary doctor
$0 copay
Specialist
$60 copay
Outpatient diagnostic tests/Lab and X-Rays
$0 - $275 copay
Urgent care
$50 copay
Maximum Out-of-Pocket (Annually)
$6,750
Ambulance services
$275 copay
Emergency room (waived if admitted to hospital within 24 hours)
$130 copay
Inpatient hospital care
$425 per day, days 1-6; $0 per day, days 7-90
Skilled nursing facility
$0 per day (Days 1‑20)
- Important Notice
For full plan details, see the Evidence of Coverage or Summary of Benefits in the Plan Documents.
Rx benefits
Tier 1 - Preferred generic
$0 copay
Tier 2 - Generic
$0 copay
Tier 3 - Preferred brand
24%
Tier 4 - Non-preferred brand
25%
Tier 5 - Specialty
25%
Additional Benefits
- Vision
- Dental
- Hearing
- SilverSneakers Gym Membership
- Worldwide Emergency Coverage