Aetna Medicare Value (PPO)

3.5 out of 5 stars* for plan year 2023
$0.00 Monthly Premium

Aetna Medicare Value (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H5521-285-000

$0.00 Monthly Premium

Michigan Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Michigan Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$4,900.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit$0 in-network / $25 out-of-network
Specialty doctor visit$35 in-network / $55 out-of-network
Inpatient hospital care$240 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 $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Emergency room visit$100 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation$275 in-network / $275 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Value (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Value (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $20.00
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring0% - 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-raysLab Services: Lab Services: $5 in-network/ $25 out-of-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $75 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $20 in-network / CT Scans: $235 in-network / Diagnostic Radiology other than CT Scans: $235 in-network / Diagnostic Radiology Mammogram: $0 in-network / 50% out-of-network, for more information see Evidence of Coverage
Home health care$0 in-network / 50% out-of-network
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $1871.00
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient careMental Health - Group Sessions: $40 in-network/ Mental Health - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage

Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $285 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 50% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse careIn-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 items$60 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $35.00
Skilled Nursing Facility (SNF) care$10 per day, days 1-20; $196 per day, days 21-100 in-network/ 35% per stay out-of-network, for more information see Evidence of Coverage

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental care$1,000 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefits$190 every year, see the Evidence of Coverage

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefits$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, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programs$0 copay for all preventive services covered under Original Medicare at zero cost sharing

When reviewing Michigan Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Michigan that offer similar benefits at similar or lower prices than the plan above. Call 1-877-890-1409 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Michigan Counties Served

Alcona Alpena Antrim Benzie Charlevoix Cheboygan Crawford Emmet Grand Traverse Iosco Kalkaska Leelanau Manistee Missaukee Montmorency Ogemaw Oscoda Otsego Presque Isle Roscommon Wexford
Back to plans in Michigan

Every 60 seconds, we help someone enroll in a Medicare Advantage plan.1

Ready to find your plan?

Or call a licensed insurance agent

1-877-890-1409

TTY 711, 24/7

Or call a licensed insurance agent

  • secure website