Your Aetna Signature PPO
Aetna Value PPO has changed their name to Aetna Signature PPO 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/H5521-195
Aetna Customer Service: 1-833-570-6670
2025
2026
Value PPO
Signature PPO
H5521-195
H5521-195
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$40 /50%
$0 / 50%
Specialist
$40 / 50%
$40 / 50%
Physical Therapy
$40 / 50%
$45 / 50%
Urgent Care
$45
$45
Hospital
$295 days 1-6
$365 days 1-7
Out of Network
50%
50%
Maximum Out Of Pocket
$4,500 / $10,100
$5,200 / $10,100 (in- and -out-of-Network)
Outpatient Surgery
$295 / 50%
$365 / 50%
Ambulance
$280 / 20% (air)
$280 / 20% (air)
Emergency
$125
$130
Lab Services
$0 / 50%
$0 / 50%
X-Rays
$20 / 50%
$20 / 50%
Complex Diagnostic
$200 / 50%
$200 / 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
$750 Allowance per ear
$500 Allowance per ear
OTC
$75 per quarter
N/A
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$1,800 Direct Member Reimbursement
$1,250 Benefit
$0 Copay for preventive services
20%-50% for comprehensive services
Dental Network
Aetna Dental PPO Network / 50%
Aetna Dental PPO Network / 50% Out-of-network
Vision
$185 (Eye Med)
$100 (Eye Med)
Your Aetna Signature PPO
Aetna Value PPO has changed their name to Aetna Signature PPO for 2026
2025
2026
Value PPO
Signature PPO
H5521-195
H5521-195
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 /50%
$0 / 50%
Specialist
$40 / 50%
$40 / 50%
Physical Therapy
$40 / 50%
$45 / 50%
Urgent Care
$45
$45
Hospital
$295 days 1-6
$365 days 1-7
Out of Network
50%
50%
MOOP Cap
$4,500 / $10,100
$5,200 / $10,100 (in- and -out-of-Network)
Outpatient Surgery
$295 / 50%
$365 / 50%
Ambulance
$280 / 20% (air)
$280 / 20% (air)
Emergency
$125
$130
Lab Services
$0 / 50%
$0 / 50%
X-Rays
$20 / 50%
$20 / 50%
Complex Diagnostic
$200 / 50%
$200 / 50%
Part D
$0 / $0 / $47 / $100
$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
$750 / ear
$500 / ear
OTC
$75 / quarter
N/A
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$1,800 Direct Member Reimbursement
$1,250 Benefit
$0 Copay for preventive services
20%-50% for comprehensive services
Dental Network
Aetna Dental PPO Network / 50%
Aetna Dental PPO Network / 50% Out-of-network
Vision
$185 (Eye Med)
$100 (Eye Med)
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/H5521-195
Aetna Customer Service: 1-833-570-6670