Your Aetna Signature Extra PPO
Aetna SmartFit has changed their name to Aetna Signature Extra for 2026
EyeMed link: AetnaMedicareVision.com
Nations Hearing Link: Aetna.Nationsbenefits.com/Hearing
Dental link: https://shorturl.at/RoEcQ
Find a Doc: Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
For a complete listing of benefits for 2026, visit http://AetnaMedicare.com/h5521-403
Aetna Customer Service: 1-833-570-6670
2025
2026
Smart Fit
(H5521-403)
Signature Extra PPO (H5521-403)
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / 50%
$0 / 50%
Specialist
$40 / 50%
$45 / 50%
Physical Therapy
$40 / 50%
$45 / 50%
Urgent Care
$35
$35
Hospital
$315 days 1-8
$355 days 1-8
Out of Network
50%
50%
Maximum Out Of Pocket
$4,700 / $8,250
$5,500 / $10,100 for in- and out-of-network services combined
Outpatient Surgery
$315 / 50%
$355 / 50%
Ambulance
$275 / 20% AIR
$275 /20% AIR
Emergency
$125
$130
Lab Services
$0 / $30
$0 / 50%
X-Rays
$0 / 50%
$15 / 50%
Complex Diagnostic
$300 / 50%
$275 / 50%
Part D (Tiers 1-4)
$0 / $0/ 24% / 25%
$0 / $0 / 24% /25%
100 Day- Mail Order
$0 / $0 / 24% / 25%
$0 / $0 / 24% / 25%
Part D Deductible
$590
$615
(applies to 3,4,5)
(applies to 3,4,5)
Hearing Aid
$500 Allowance per ear
$500 Allowance per ear
OTC
$60 / quarter
N/A
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$2,200 Direct Member Reimbursement
$2000 Benefit
$0 Copay for preventive services
20%-30% coinsurance for comprehensive services
Dental Network
Aetna Dental PPO Network / 80% coinsurance out of network
Aetna Dental PPO Network / 50%-70% coinsurance for preventive and comprehensive services for out-of-network services
Vision
$160 (Eye Med)
$150 (Eye Med)
Extras
$90 per Quarter for fitness reimbursement
$90 per Quarter for fitness reimbursement
Your Aetna Signature Extra PPO
Aetna SmartFit has changed their name to Aetna Signature Extra for 2026
2025
2026
Smart Fit
Signature Extra PPO
H5521-403
H5521-403
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / 50%
$0 / 50%
Specialist
$40 / 50%
$45 / 50%
Physical Therapy
$35 / 50%
$45 / 50%
Urgent Care
$35
$35
Hospital
$315 days 1-8
$355 days 1-8
Out of Network
50%
50%
MOOP Cap
$4,200 / $8,250
$5,500 / $10,100 for in- and out-of-network services combined
Outpatient Surgery
$315 / 50%
$355 / 50%
Ambulance
$275 / 20% (air)
$275 / 20% (air)
Emergency
$125
$130
Lab Services
$0 / $30
$0 / 50%
X-Rays
$0 / 50%
$15 / 50%
Complex Diagnostic
$300 / 50%
$275 / 50%
Part D (Tiers 1-4)
$0 / $0 / 24% / 25%
$0 / $0 / 24% / 25%
100 Day- Mail Order
$0 / $0 / 24% / 25%
$0 / $0 / 24% / 25%
Part D Deductible
$590
$615
(applies to 3,4,5)
(applies to 3,4,5)
Hearing Aid
$500 Allowance per ear
$500 Allowance per ear
OTC
$60 / quarter
N/A
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$2,200 Direct Member Reimbursement
$2000 Benefit
$0 Copay for preventive services
20%-30% coinsurance for comprehensive services
Dental Network
Aetna Dental PPO Network / 80% coinsurance out of network
Aetna Dental PPO Network / 50%-70% coinsurance for preventive and comprehensive services for out-of-network services
Vision
$160 (Eye Med)
$150 (Eye Med)
Extras
$90 per Quarter for fitness reimbursement
$90 per Quarter for fitness reimbursement
EyeMed link: AetnaMedicareVision.com
Nations Hearing Link: Aetna.Nationsbenefits.com/Hearing
Dental link: https://shorturl.at/RoEcQ
Find a Doc: Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
For a complete listing of benefits for 2026, visit http://AetnaMedicare.com/h5521-403
Aetna Customer Service: 1-833-570-6670