Aetna Medicare Enhanced Extra (PPO)

SILVERSCRIPT INSURANCE COMPANY · 2027 plan year

Plan ID H2293-039-000

Local PPO★ 3.5 CMS StarsNew for 2027
MOOP (in-network)
$7,150
MOOP (combined)
$10,750
Monthly premium
$60/mo
Part C $42.20 + Part D $17.80, before Extra Help
Prescription drugs
Included

Plan information

Contract / Plan / Segment
H2293-039-000
Medical deductible
$0 — no deductible
Part D premium
$17.80/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$700/yr
Also owed
Your Medicare Part B premium, paid separately

More SILVERSCRIPT INSURANCE COMPANY plans in TX

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$455/day for days 1–6, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$300/day for days 1–6, $0 after
Worldwide Urgent Care Coverage$130

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions$35
Mental Health — Group Sessions$35
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Cardiac & Pulmonary RehabilitationSee plan details
Diagnostic Tests & Lab ServicesSee plan details
Digital Rectal ExamsNo charge
Skilled Nursing Facility (SNF)$10/day for days 1–20, $221/day for days 21–100
Cardiac Rehabilitation — Additional Sessions$20
Intensive Cardiac Rehabilitation — Additional Sessions$20
Pulmonary Rehabilitation — Additional Sessions$15
Supervised Exercise Therapy (SET)$25
Emergency Services$130
Urgently Needed Services$50
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$130
Worldwide Emergency Transportation$300
Partial Hospitalization Program$85
Intensive Outpatient Program (IOP)$85
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$15
Occupational Therapy Services$35
Physician Specialist Services$0-$50
Podiatry Services$50
Other Health Care Professional Services$0-$50
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$35
Psychiatric Services — Group Sessions$35
Physical Therapy & Speech-Language Pathology$35
Additional Telehealth Services (Part B)$0-$50 copay + 20% coinsurance
Opioid Treatment Program Services$35
Diagnostic Procedures & Tests$0-$50
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic Radiology$0-$230
Therapeutic Radiology20% coinsurance
X-Ray Services$0-$35
Outpatient Hospital Services$0-$350
Hospital Observation Services$455 per stay
Ambulatory Surgical Center (ASC)$0-$300
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$35
Substance Abuse — Group Sessions$35
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$300
Air Ambulance20% coinsurance
Durable Medical Equipment (DME)20% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices20% coinsurance
Medical Supplies0%-20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic Supplies0%-20% coinsurance
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic Monitors0%-20% coinsurance
Dialysis Services20% coinsurance
Over-the-Counter (OTC) ItemsNo charge
Other Supplemental BenefitNo charge
Other Supplemental BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Health EducationNo charge
Smoking & Tobacco Cessation CounselingNo charge
Fitness BenefitNo charge
Remote Access TechnologiesNo charge
Wigs for Chemotherapy Hair LossNo charge
Kidney Disease Education Services20% coinsurance
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)$35
Dental — Medicare-Covered Services$50
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Prophylaxis (Cleaning)No charge
Vision — Eye ExamsNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — Other Eye ServicesNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Vision — Eyewear UpgradesNo charge
Hearing — Exams$50
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)No charge

Service area

  • TX: 6 counties

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