Aetna Medicare Enhanced Extra (PPO)

Available to residents of Richardson County, NE for 2026. Contract H1608, plan 118, segment 0.

New for 2026. This plan has no 2025 predecessor in the CMS crosswalk.

Plan details

Monthly premium (Part C + D)	$52.00
— medical (Part C) part	$0.00
— drug (Part D) part	$52.00?
Monthly premium with full Extra Help (LIS)	$10.50?
Part B premium reduction (giveback)	None
In-network out-of-pocket maximum	$5,000.00?
In- and out-of-network out-of-pocket maximum	$10,000.00
Drug deductible	$615.00Tier 1 and 2 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PPO?
Contract / plan	H1608-118-0
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: 4 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 H1608 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	$35 copay
Specialist	$35 copay	$65 copay
Other health care professional	$0–$35 copay	$0–$65 copay
Additional telehealth services	$0–$50 copay; 20% coinsurance(authorization required)	—
Preventive care
Medicare-covered preventive services	$0 copay	0%–40% coinsurance
Annual physical exam	$0 copay	40% coinsurance
Kidney disease education	20% coinsurance	50% coinsurance
Glaucoma screening	$0 copay	40% coinsurance
Diabetes self-management training	$0 copay	40% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$20 copay(authorization required)	40% coinsurance
Lab services	$0 copay(authorization required)	$30 copay
Diagnostic radiology (e.g. MRI, CT)	$0–$250 copay(authorization required)	40% coinsurance
Therapeutic radiology	20% coinsurance(authorization required)	40% coinsurance
Outpatient x-rays	$10 copay(authorization required)	40% coinsurance
Emergency and urgent care
Emergency room	$130 copay	—
Urgent care	$50 copay	—
Worldwide emergency coverage	$130 copay · $250,000 plan limit	—
Worldwide urgent care	$130 copay · $250,000 plan limit	—
Worldwide emergency transportation	$245 copay	—
Hospital care
Inpatient hospital stay	$325 per day for days 1–5; $0 per day for days 6–90(authorization required)	40% coinsurance per stay
Outpatient hospital services	$0–$325 copay(authorization required)	40% coinsurance
Outpatient observation	$325 copay(authorization required)	40% coinsurance
Ambulatory surgical center	$0–$275 copay(authorization required)	40% coinsurance
Outpatient blood services	$0 copay	40% 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)	40% coinsurance per stay
Home health care	$0 copay(authorization required)	40% coinsurance
Kidney dialysis	20% coinsurance(authorization required)	50% coinsurance
Rehabilitation
Occupational therapy	$35 copay	40% coinsurance
Physical therapy and speech-language therapy	$35 copay	40% coinsurance
Cardiac rehabilitation	$20 copay	40% coinsurance
Pulmonary rehabilitation	$15 copay	40% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$370 per day for days 1–5; $0 per day for days 6–90(authorization required)	40% coinsurance per stay
Outpatient mental health, individual session	$40 copay(authorization required)	40% coinsurance
Outpatient mental health, group session	$40 copay(authorization required)	40% coinsurance
Psychiatrist, individual session	$40 copay(authorization required)	40% coinsurance
Psychiatrist, group session	$40 copay(authorization required)	40% coinsurance
Partial hospitalization	$55 copay(authorization required)	40% coinsurance
Intensive outpatient program	$145 copay(authorization required)	40% coinsurance
Outpatient substance use, individual session	$40 copay(authorization required)	40% coinsurance
Outpatient substance use, group session	$40 copay(authorization required)	40% coinsurance
Opioid treatment program	$40 copay(authorization required)	40% coinsurance
Ambulance and transportation
Ground ambulance	$245 copay(authorization required)	$245 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)	0%–20% coinsurance(authorization required)	40% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance(authorization required)	40% coinsurance
Medical supplies	0%–20% coinsurance(authorization required)	40% coinsurance
Diabetes supplies	0%–20% coinsurance(authorization required)	0%–20% coinsurance
Diabetic therapeutic shoes or inserts	20% coinsurance(authorization required)	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay	40% coinsurance
Routine chiropractic care	Not covered	—
Acupuncture	Not covered	—
Foot exams and treatment (Medicare-covered)	$35 copay	40% coinsurance
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	$35 copay(authorization required)	40% coinsurance
Preventive dental plan limit	$2,000 plan limit every year	—
Oral exams	$0 copay	50% coinsurance
Cleanings	$0 copay	50% coinsurance
Fluoride treatment	$0 copay	50% coinsurance
Dental x-rays	$0 copay	50% coinsurance
Other diagnostic dental services	$0 copay	50% coinsurance
Other preventive dental services	$0 copay	50% coinsurance
Restorative services (fillings, crowns)	$0 copay	50% coinsurance
Endodontics (root canals)	$0 copay	50% coinsurance
Periodontics (gum disease)	$0 copay	50% coinsurance
Dentures and other removable prosthodontics	$0 copay	50% coinsurance
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	$0 copay	50% coinsurance
Oral and maxillofacial surgery	$0 copay	50% coinsurance
Orthodontics	Not covered	—
Adjunctive general services	$0 copay	50% coinsurance
Vision?
Eye exam (Medicare-covered)	$0 copay(limits apply)	40% coinsurance
Routine eye exam	$0 copay(limits apply)	0% coinsurance
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	40% coinsurance
Eyewear plan limit	$250 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)	$0 copay	40% coinsurance
Routine hearing exam	$0 copay(limits apply)	40% coinsurance
Hearing aid fitting and evaluation	$0 copay(limits apply)	40% coinsurance
Hearing aid plan limit	$1,250 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)	40% coinsurance
Other Part B drugs	0%–20% coinsurance(authorization required, step therapy may apply)	40% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	$50 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)	40% coinsurance
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 57 other NE counties

Benefits in plain text

Aetna Medicare Enhanced Extra (PPO) (H1608-118-0) is a 2026 PPO Medicare Advantage plan offered by Aetna Medicare, available to residents of Richardson County, NE.

The monthly premium is $52.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $10.50.

Its in-network out-of-pocket maximum is $5,000.00.

The combined in- and out-of-network out-of-pocket maximum is $10,000.00.

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 (H1608) an overall rating of 4 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.