2027 Medicare Advantage plan
Aetna Medicare Advantra Enhanced Classic (PPO): 2027 benefits and costs
Aetna Medicare PPO
CMS plan ID: H1608-027-0 · Plan year: 2027
Aetna Medicare Advantra Enhanced Classic (PPO) is a 2027 Medicare Advantage plan offered by Aetna Medicare. It is listed in West Virginia.
2027 plan costs at a glance
- Organization
- Aetna Medicare
- Plan organization
- COVENTRY HEALTH AND LIFE INSURANCE COMPANY
- Parent company
- CVS Health Corporation
- Plan type
- PPO
- Part C premium
- $19.90
- Part D premium
- $11.10
- Prescription drug coverage
- Yes
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $7,150.00
Applies to certain in-network supplemental services.
- Combined in/out-of-network medical maximum
- $10,750.00
Applies to certain out-of-network supplemental services and certain in-network supplemental services.
- Out-of-network medical maximum
- Not applicable
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0.00 copay
| 20% coinsurance
| |
| Specialist visit | $30.00 copay
| 20% coinsurance
|
|
| Telehealth | $0.00 to $50.00 copay; 20% coinsurance
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $130.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $50.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0.00 copay
| 45% coinsurance
|
|
| Dialysis | 20% coinsurance
| 50% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 20% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 20% coinsurance
|
|
| Kidney disease education services | 20% coinsurance
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| 20% coinsurance
|
|
| Medicare-covered foot care | $30.00 copay
| 20% coinsurance
|
|
| Other health professionals | $0.00 to $30.00 copay
| 0% to 20% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–7: $225.00 copay per day Days 8–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–5: $325.00 copay per day Days 6–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $10.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $0.00 to $225.00 copay
| 20% coinsurance
| |
| Hospital observation services | $225.00 copay
| 20% coinsurance
| |
| Ambulatory surgical center | $0.00 to $175.00 copay
| 20% coinsurance
|
|
| Outpatient blood | $0.00 copay
| 20% coinsurance
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 copay
| 20% coinsurance
|
|
| Laboratory services | $0.00 copay
| 20% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $0.00 to $225.00 copay
| 20% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 20% coinsurance
|
|
| X-rays | $10.00 copay
| 20% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $0.00 copay
| 45% coinsurance
|
|
| Intensive outpatient program | $0.00 copay
| 45% coinsurance
|
|
| Substance use treatment, individual sessions | $30.00 copay
| 45% coinsurance
|
|
| Substance use treatment, group sessions | $30.00 copay
| 45% coinsurance
|
|
| Opioid treatment program | $30.00 copay
| 45% coinsurance
|
|
| Mental health, individual sessions | $30.00 copay
| 45% coinsurance
|
|
| Mental health, group sessions | $30.00 copay
| 45% coinsurance
|
|
| Psychiatry, individual sessions | $30.00 copay
| 45% coinsurance
|
|
| Psychiatry, group sessions | $30.00 copay
| 45% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $30.00 copay
| 20% coinsurance
|
|
| Physical and speech therapy | $30.00 copay
| 20% coinsurance
|
|
| Cardiac rehabilitation | $0.00 copay
| 20% coinsurance
|
|
| Intensive cardiac rehabilitation | $0.00 copay
| 20% coinsurance
|
|
| Pulmonary rehabilitation | $0.00 copay
| 20% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $0.00 copay
| 20% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $300.00 copay
| $300.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 30% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 30% coinsurance
|
|
| Medical supplies | 0% to 20% coinsurance
| 30% coinsurance
|
|
| Diabetic supplies | 0% to 20% coinsurance
| 0% to 20% coinsurance
|
|
| Diabetic shoes and inserts | 20% coinsurance
| 20% coinsurance
|
|
| Diabetic monitors | 0% to 20% coinsurance
| 0% to 30% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | $30.00 copay | 20% coinsurance
| |
| Oral examsAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0.00 copay | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 50% coinsurance | 70% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 50% coinsurance | 70% coinsurance
| |
| Oral surgeryAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
| |
| Other dental servicesAdditional plan benefit | 20% to 50% coinsurance | 50% to 70% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0.00 to $30.00 copay
| 20% coinsurance
|
|
| Routine eye examsAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Medicare-covered eyewear | $0.00 copay
| 20% coinsurance
|
|
| Contact lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass lensesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
| Eyeglass framesAdditional plan benefit | $0.00 copay | $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Other Eye Exam ServicesAdditional plan benefit | Out-of-network | 20% coinsurance
| |
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| UpgradesAdditional plan benefit | Out-of-network | $0.00 copay
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $30.00 copay
| 20% coinsurance
|
|
| Routine hearing examsAdditional plan benefit | $0.00 copay | 20% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0.00 copay | 20% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0.00 copay
| $0.00 copay
| |
| Limited-duration mealsAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
| Annual physical examAdditional plan benefit | $0.00 copay
| 20% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0.00 copay
| $0.00 copay
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 20% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 0% to 20% coinsurance
| |
| Health EducationAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Additional Sessions of Smoking and Tobacco Cessation CounselingAdditional plan benefit | Out-of-network | 20% coinsurance
|
|
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0.00 copay
|
|
| Wigs for chemotherapy-related hair lossAdditional plan benefit | Out-of-network | $0.00 copay
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 20% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 20% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | $0.00 copay
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | $0.00 copay
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay
|
Allowances and optional benefits
Benefits for qualifying members
Healthy Heart (CHF)
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Other 1
- Qualifying conditions
- Chronic heart failure
- To qualify
- Participation in a Care Management Program
- Covered package services cost $0 until the package limit is reached
- No
- Benefits that apply to reduced cost sharing
- Medicare-covered benefits
- Medicare benefits that apply to reduced cost sharing
- Physician Specialist Services; Additional Telehealth Benefits
- Does your MA Uniformity Flexibility/SSBCI cost reduction cover all or some Specialists under Physician Specialist Services?
- Some specialists
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Benefits that apply to being exempt from the plan-level deductible
- Medicare-covered benefits
- Medicare benefits that are exempt from the plan level deductible
- Physician Specialist Services; Additional Telehealth Benefits
- Do you offer reduced Coinsurance?
- No
- Service-specific deductible
- No
- Reduced Copayment?
- Yes
- Types of benefits that apply to the copayment cost sharing
- Medicare-covered benefits
- Medicare-covered benefits that will receive reduced Copayment
- Additional Telehealth Benefits
- Minimum Copayment for Additional Telehealth Benefits
- $0.00
- Maximum Copayment for Additional Telehealth Benefits
- $0.00
- Specialists reduced coinsurance?
- No
- Specialists reduced copayment?
- Yes
- Specialists with the reduced copayment
- Pulmonology; Nephrology; Endocrinology; Cardiology
- Minimum Copayment Amount for Cardiology
- $0.00
- Maximum Copayment Amount for Cardiology
- $0.00
- Minimum Copayment Amount for Endocrinology
- $0.00
- Maximum Copayment Amount for Endocrinology
- $0.00
- Minimum Copayment Amount for Nephrology
- $0.00
- Maximum Copayment Amount for Nephrology
- $0.00
- Minimum Copayment Amount for Pulmonology
- $0.00
- Maximum Copayment Amount for Pulmonology
- $0.00
Full package terms are not summarized here.
SSBCI Pkg
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Chronic heart failure
- To qualify
- Participation in a Care Management Program
- Included services
- Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
- Package limit
- $75.00
- How often this limit applies
- Every three months
- How benefits are provided
- Debit Card
- Services sharing the package limit
- Transportation to health-related locations; Over-the-counter health items; Food and produce; Transportation for non-medical needs; Support for daily living; Other 1 Non-Primarily Health Related Benefit
Full package terms are not summarized here.
Recovery at Home Program
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Other 5; Congestive Heart Failure (CHF); Other 1; Other 2; Other 3; Other 4
- Qualifying conditions
- Fractures
- Qualifying conditions
- Neurologic Disorders
- Qualifying conditions
- Musculoskeletal (MSK)
- Qualifying conditions
- Pneumonia
- Qualifying conditions
- Urologic Conditions
- All listed conditions required
- No
- Combination of conditions required
- No
- To qualify
- Participation in a Care Management Program
- Included services
- In-Home Support Services
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- In-Home Support Services
Healthy Heart (CHF)
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Other 1
- Qualifying conditions
- Chronic heart failure
- To qualify
- Participation in a Care Management Program
- Included services
- Over-the-counter health items; Meal Benefit; Home and Bathroom Safety Devices and Modifications
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- Yes
- Services exempt from the deductible
- Over-the-counter health items; Meal Benefit; Home and Bathroom Safety Devices and Modifications
Prescription drug coverage
Costs shown are for initial coverage.
Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.
Preferred retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $5.00 | $10.00 | $15.00 |
| Tier 3Preferred Brand | 17% | 17% | 17% |
| Tier 4Non-Preferred Drug | 28% | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Standard retail costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $5.00 | $10.00 | $15.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | 17% | 17% | 17% |
| Tier 4Non-Preferred Drug | 28% | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Mail-order and other pharmacies
Out-of-network pricing: The standard retail copay or coinsurance applies, but the number of days you can fill is limited. Check the supply lengths below and the plan’s out-of-network rules.
Preferred mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $0.00 | $0.00 | $0.00 |
| Tier 2Generic | $5.00 | $5.00 | $5.00 |
| Tier 3Preferred Brand | 17% | 17% | 17% |
| Tier 4Non-Preferred Drug | 28% | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Standard mail order costs
On a small screen, scroll the table sideways to compare all fill lengths.
| Drug tier | 30 days | 60 days | 100 days |
|---|---|---|---|
| Tier 1Preferred Generic | $5.00 | $10.00 | $15.00 |
| Tier 2Generic | $12.00 | $24.00 | $36.00 |
| Tier 3Preferred Brand | 17% | 17% | 17% |
| Tier 4Non-Preferred Drug | 28% | 28% | 28% |
| Tier 5Specialty Tier | 25% | Not listed | Not listed |
Long-term care pharmacy costs
| Drug tier | 31 days |
|---|---|
| Tier 1Preferred Generic | $5.00 |
| Tier 2Generic | $12.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 28% |
| Tier 5Specialty Tier | 25% |
Out-of-network pharmacy costs
| Drug tier | 10 days |
|---|---|
| Tier 1Preferred Generic | $5.00 |
| Tier 2Generic | $12.00 |
| Tier 3Preferred Brand | 17% |
| Tier 4Non-Preferred Drug | 28% |
| Tier 5Specialty Tier | 25% |
Drug coverage rules and exceptions
Tier 1: Preferred Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 2: Generic
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 3: Preferred Brand
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 4: Non-Preferred Drug
- Drugs included in this tier
- Part D Drugs Only
- Longer fills available for every covered drug
- Yes
- Some longer-fill prescriptions require a one-month first fill
- No
Tier 5: Specialty Tier
- Drugs included in this tier
- Part D Drugs Only
- Initial-coverage prices also apply to drugs exempt from the deductible
- Yes
Special cost protections apply to covered insulin and recommended adult vaccines.
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 18 county listings across 1 state or territory
West Virginia
- Braxton, West Virginia
- Cabell, West Virginia
- Calhoun, West Virginia
- Fayette, West Virginia
- Gilmer, West Virginia
- Greenbrier, West Virginia
- Jackson, West Virginia
- Kanawha, West Virginia
- Mason, West Virginia
- McDowell, West Virginia
- Mercer, West Virginia
- Mingo, West Virginia
- Pendleton, West Virginia
- Pleasants, West Virginia
- Putnam, West Virginia
- Raleigh, West Virginia
- Wayne, West Virginia
- Wirt, West Virginia