Aetna Medicare Enhanced (PPO)

Available to residents of Muscogee County, GA for 2026. Contract H3288, plan 042, segment 0.

Renewed for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$43.00
— medical (Part C) part	$0.00
— drug (Part D) part	$43.00?
Monthly premium with full Extra Help (LIS)	$17.60?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$9,250.00?
In- and out-of-network out-of-pocket maximum	$13,900.00
Drug deductible	$615.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO?
Contract / plan	H3288-042-0
Offered by	Aetna Medicare
Parent organization	CVS Health Corporation
Formulary drugs	3,715
Formulary exception tier	4?
Pharmacy search	www.aetnamedicare.com/findpharmacy
Member services	(833)859-6031TTY 711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3.5 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H3288 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	$30 copay
Specialist	$0–$35 copay	50% coinsurance
Other health care professional	$0–$35 copay	0%–50% coinsurance
Additional telehealth services	$0–$50 copay; 20% coinsurance(authorization required)	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay
Annual physical exam	$0 copay	50% coinsurance
Kidney disease education	20% coinsurance	50% coinsurance
Glaucoma screening	$0 copay	50% coinsurance
Diabetes self-management training	$0 copay	50% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$95 copay(authorization required)	50% coinsurance
Lab services	$0–$20 copay(authorization required)	50% coinsurance
Diagnostic radiology (e.g. MRI, CT)	$0–$300 copay(authorization required)	50% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	50% coinsurance
Outpatient x-rays	$0–$95 copay(authorization required)	50% coinsurance
Emergency and urgent care
Emergency room	$115 copay	—
Urgent care	$40 copay	—
Worldwide emergency coverage	$115 copay · $250,000 plan limit	—
Worldwide urgent care	$115 copay · $250,000 plan limit	—
Worldwide emergency transportation	$295 copay	—
Hospital care
Inpatient hospital stay	$407 per day for days 1–6; $0 per day for days 7–90(authorization required)	50% coinsurance per stay
Outpatient hospital services	$0–$450 copay(authorization required)	50% coinsurance
Outpatient observation	$407 copay(authorization required)	50% coinsurance
Ambulatory surgical center	$0–$350 copay(authorization required)	50% coinsurance
Outpatient blood services	$0 copay	50% coinsurance
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $218 per day for days 21–100(authorization required)	50% coinsurance per stay
Home health care	$0 copay(authorization required)	50% coinsurance
Kidney dialysis	20% coinsurance(authorization required)	50% coinsurance
Rehabilitation
Occupational therapy	$35 copay	50% coinsurance
Physical therapy and speech-language therapy	$50 copay	50% coinsurance
Cardiac rehabilitation	$25 copay	50% coinsurance
Pulmonary rehabilitation	$15 copay	50% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$407 per day for days 1–5; $0 per day for days 6–90(authorization required)	50% coinsurance per stay
Outpatient mental health, individual session	$30 copay(authorization required)	50% coinsurance
Outpatient mental health, group session	$30 copay(authorization required)	50% coinsurance
Psychiatrist, individual session	$30 copay(authorization required)	50% coinsurance
Psychiatrist, group session	$30 copay(authorization required)	50% coinsurance
Partial hospitalization	$105 copay(authorization required)	50% coinsurance
Intensive outpatient program	$110 copay(authorization required)	50% coinsurance
Outpatient substance use, individual session	$30 copay(authorization required)	50% coinsurance
Outpatient substance use, group session	$30 copay(authorization required)	50% coinsurance
Opioid treatment program	$30 copay(authorization required)	50% coinsurance
Ambulance and transportation
Ground ambulance	$295 copay(authorization required)	$295 copay
Air ambulance	20% coinsurance(authorization required)	20% coinsurance
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	20% coinsurance(authorization required)	45% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	45% coinsurance
Medical supplies	20% coinsurance(authorization required)	45% coinsurance
Diabetes supplies	0%–20% coinsurance(authorization required)	0%–20% coinsurance
Diabetic therapeutic shoes or inserts	$10 copay(authorization required)	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay(authorization required)	50% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	$35 copay	50% coinsurance
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	$35 copay(authorization required)	50% coinsurance
Oral exams	$0 copay(limits apply)	50% coinsurance
Cleanings	$0 copay(limits apply)	50% coinsurance
Fluoride treatment	Not covered	—
Dental x-rays	$0 copay(limits apply)	50% coinsurance
Other diagnostic dental services	Not covered	—
Other preventive dental services	Not covered	—
Comprehensive dental plan limit	$1,750 plan limit every year	—
Endodontics (root canals)	20% coinsurance(limits apply)	50% coinsurance
Dentures and other removable prosthodontics	50% coinsurance(limits apply)	70% coinsurance
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	50% coinsurance(limits apply)	70% coinsurance
Orthodontics	Not covered	—
Vision?
Eye exam (Medicare-covered)	$0–$35 copay(limits apply)	35% coinsurance
Routine eye exam	$0 copay(limits apply)	$0 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	35% coinsurance
Eyewear plan limit	$275 plan limit every year	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	$0 copay(limits apply)	$0 copay
Eyeglass lenses	$0 copay(limits apply)	$0 copay
Eyeglass frames	$0 copay(limits apply)	$0 copay
Eyewear upgrades	$0 copay(limits apply)	$0 copay
Hearing?
Hearing exam (Medicare-covered)	$35 copay	35% coinsurance
Routine hearing exam	$0 copay(limits apply)	35% coinsurance
Hearing aid fitting and evaluation	$0 copay(limits apply)	35% coinsurance
Hearing aid plan limit	$500 plan limit every year	—
Hearing aids (all types)	$0 copay(limits apply)	$0 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	$35 copay(authorization required, step therapy may apply)	$35 copay
Chemotherapy and radiation drugs	0%–20% coinsurance(authorization required, step therapy may apply)	50% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	50% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	$120 allowance every three months	—
Meals after a hospital stay or for a chronic condition	$0 copay	$0 copay
Fitness benefit	$0 copay(limits apply)	$0 copay
Health education	$0 copay(limits apply)	$0 copay
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	$0 copay(limits apply)	$0 copay
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	$0 copay(limits apply)	$0 copay
Home and bathroom safety devices	Not covered	—
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	$0 copay(limits apply)	$0 copay
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$0.00
Tier 3	24%
Tier 4	25%
Tier 5	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$2.00	$0.00	$0.00	$6.00	$0.00
Tier 2: Generic	$0.00	$12.00	$0.00	$0.00	$36.00	$0.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$2.00	$0.00	$0.00	$6.00	$0.00
Tier 2: Generic	$0.00	$12.00	$0.00	$0.00	$36.00	$0.00
Tier 3: Preferred Brand	24%	24%	24%	24%	24%	24%
Tier 4: Non-Preferred Drug	25%	25%	25%	25%	25%	25%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Also available in 76 other GA counties

Benefits in plain text

Aetna Medicare Enhanced (PPO) (H3288-042-0) is a 2026 PPO Medicare Advantage plan offered by Aetna Medicare, available to residents of Muscogee County, GA.

The monthly premium is $43.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $17.60.

Its in-network out-of-pocket maximum is $9,250.00.

The combined in- and out-of-network out-of-pocket maximum is $13,900.00.

The drug deductible is $615.00. Tier 1 and 2 exempt.

The plan's formulary lists 3,715 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: 24%; tier 4: 25%; tier 5: 25%.

CMS gives the plan's contract (H3288) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.