Prior Authorization Required [snf] =>
Prior Authorization Required [pcp] => $0.00 Copay [specialist] => $20.00 Copay [urgent_care] => $30.00 Copay [er] => $0.00 - $325.00 Copay
Prior Authorization Required [ambulance_ground] => $290.00 Copay [ambulance_air] => $290.00 Copay
Prior Authorization Required [dental] =>
$1550 max [vision] => $0.00 Copay
$315/yr eyewear [hearing] => Not Covered [rx] => Array ( [deductible] => $250.00 [tiers] => Array ( [0] => Array ( [order] => 1 [name] => Tier 1 [deductible] => Excluded [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [1] => Array ( [order] => 2 [name] => Tier 2 [deductible] => Excluded [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [2] => Array ( [order] => 3 [name] => Tier 3 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [3] => Array ( [order] => 4 [name] => Tier 4 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) [4] => Array ( [order] => 5 [name] => Tier 5 [deductible] => Applies [retail_30] => [retail_90] => [mail_30] => [mail_90] => [ltc_30] => [out_network] => [post_oop] => ) ) ) )
Aetna Medicare Value Plus (PPO) (PPO) 2025 Plan Details for Allen County, Kentucky Residents
Aetna Medicare Value Plus (PPO) (PPO) 2025 Plan Details for Allen County, Kentucky Residents
Aetna Medicare Value Plus (PPO) is a PPO Medicare Advantage plan, from Aetna Medicare, {with_without_pdp} a prescription drug plan. It's CMS Plan ID is: H5521-490-0. It is not available in all areas. The list of locations where this plan is available can be found below.
According to CMS enrollment data (July, 2025), there are approximately 2,217 members enrolled in this plan.
Aetna Medicare Value Plus (PPO) (PPO) Overview
| CMS Fact | Landscape Value |
|---|---|
| Health Plan ID: | H5521-490-0 |
| CMS Overall Rating: | 0.0 out of 5 stars* |
| Medicare Advantage Plan Type: | PPO |
| Coverage Year: | CY2026 |
| Monthly Premium: | $38.40 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $5500.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Allen County, KY |
| Insured By: | Aetna Medicare |
| Last Plan Content Update: |
Plan Availability by Location
Health Plan Out-of-Pocket Costs
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $30 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $40 Copay |
| Ground ambulance: | $290 Copay |
| Inpatient hospital care: | $285.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $30 Copay |
| Routine Foot Care: | $30 Copay |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $40 Copay |
| Outpatient group therapy: | $40 Copay |
| Inpatient psychiatric hospital care: | $285.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $30 Copay |
| Occupational therapy: | $30 Copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | 20% Coinsurance Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $100 Copay Prior Authorization Required |
| Lab services: | $0 Copay Prior Authorization Required |
| Outpatient x-rays: | $20 Copay Prior Authorization Required |
| Diagnostic tests and procedures: | $50 Copay Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $30 Copay Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $30 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $315.00 Every year |
Prescription Drug Costs & Benefits
Aetna Medicare Value Plus (PPO) includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $$38.40 |
|---|---|
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $$38.40 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $$38.40 |
| Low-Income Subsidy Premium: | $$0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $615.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Aetna Medicare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Aetna Medicare Value Plus (PPO) may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $2.00 |
| Generic* | $10.00 | $12.00 |
| Preferred Brand | 25.00% | 25.00% |
| Non-Preferred Drug | 26.00% | 26.00% |
| Specialty Tier | 30.00% | 30.00% |
| *Deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Need Help Enrolling?
| Website: | Aetna Medicare Plan Page |
|---|---|
| Providers: | Aetna Medicare Providers Page |
| Formulary: | Aetna Medicare Formulary Page |
| Pharmacy: | Aetna Medicare Pharmacy Page |
| New Member Health Plan Help: | (833)859-6031 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)859-6031 |
| New Member Part D TTY Users: | 711 |
Frequently Asked Questions
📘 What does Medicare plan code H5521 490 mean?
Aetna Medicare Value Plus (PPO) is a Medicare Advantage plan by Aetna Medicare. The code H5521 is the CMS contract ID, whereas 490 is its plan ID.
- Plan Name: Aetna Medicare Value Plus (PPO)
- Plan Type: PPO
- Premium: $38.40/mo + your monthly Part B premium
- Out-of-Pocket Max: $5500.00 (in-network)
- Drug Coverage: {pdp_faq_summary}
- CMS Star Rating: 0.0 out of 5
- Contract Year: 2026
This information is based on official CMS data and is provided for educational purposes. Always review your plan’s official documents or contact the provider directly before making enrollment decisions.
📋 What type of plan is H5521 490?
This plan is a PPO — specifically, it's an PPO plan with a Medicare Advantage contract that's offered by Aetna Medicare. It comes with defined provider network rules you should be aware of.
- Plan Marketing Name: Aetna Medicare Value Plus (PPO)
- Network Type: {plan_type_expanded}
- Referral Requirement: {referral_required_expanded}
- Prescription Coverage: {pdp_faq_summary}
Plan types like HMOs and PPOs determine whether you can go out-of-network or need referrals to see specialists.
📦 What benefits are included in H5521 490?
This plan covers all Medicare Part A and Part B services. Depending on the plan, it may also include valuable extras like dental, vision, and hearing benefits.
- Medical Services: Hospital, doctor visits, preventive care
- Prescription Drugs: Enhanced, $615.00 deductible
- Dental: {dental_benefit}
- Vision: {vision_benefit}
- Hearing: {hearing_benefit}
Benefit availability may vary by location and plan version. Confirm specific details in your plan's Evidence of Coverage (EOC).