H5521-404 — Aetna Medicare Signature Extra (PPO) — 2026 Medicare Advantage Prescription Drug Plan
Aetna Medicare
Plan ID: H5521-404 · Contract: H5521
Use this Medicare plan ID to verify you are comparing the exact 2026 plan before checking benefits, county availability, drug coverage, provider networks, and costs.
Plan history: Few changes identified
Based only on the year-over-year CMS records available to Medicare Choose. This is not a CMS rating and does not predict future premiums, benefits, provider networks, or plan availability.
Why this summary appears:
The available history is limited to the renewal record. It does not confirm that every cost, benefit, or network detail stayed the same.
How this PPO works
A PPO generally lets you use in-network or out-of-network providers that accept the plan, but out-of-network care can cost more. You usually do not need a referral for specialists. Always confirm that a provider accepts this specific plan.
Monthly Premium
$0/mo
This is the plan premium shown in CMS data. You must continue paying your Medicare Part B premium unless another program pays it for you.
Medical Deductible
Not available
CMS data does not list a medical deductible for this plan. This does not mean the cost is $0.
Drug Deductible
$615
Max Out-of-Pocket
$4,700
Common Medical Cost Sharing
A copay is a fixed dollar amount. Coinsurance is a percentage of the allowed cost. The amount you owe can depend on the service, provider, network, and plan rules.
$0 copay
Primary Care
Not available in the CMS data
Specialist
$130 copay
Emergency Room
$35 copay
Urgent Care
Supplemental Benefits
Benefit Details
Preventive Dental
$40 copay
Comprehensive Dental
Coverage included; review plan details for limits
Vision - Eye Exams
$0 copay
Vision - Eyewear
Coverage included; review plan details for limits
Hearing Exams & Aids
Coverage included; review plan details for limits
Meals
Coverage included; review plan details for limits
Transportation
$0 copay
Telehealth
$0 copay
Drug Coverage Summary
Drug Deductible
$615
Drug Premium
$0/mo
This plan includes Part D prescription drug coverage. Drug costs depend on which tier your medications fall under. Use our comparison tool to estimate your specific drug costs.
Medical Benefits
Inpatient Hospital
In-network: Not available in the CMS data
Emergency Room
In-network: $130 copay
Urgent Care
In-network: $35 copay
Primary Care
In-network: $0 copay
Specialist
In-network: Not available in the CMS data
Outpatient Hospital
In-network: Not available in the CMS data
Dental - Preventive
In-network: $40 copay
Dental - Comprehensive
In-network: Not available in the CMS data
Vision - Eye Exams
In-network: $0 copay
Hearing - Exams & Aids
In-network: Not available in the CMS data
Counties Served (13)
Data Source and Verification
Sources: Centers for Medicare & Medicaid Services (CMS) public-use data. The following CMS pages provide the source files and their documentation:
- Plan premiums and service areas — CMS Landscape files
- Plan Benefit Package (PBP) benefits data
- Monthly Part D formulary and pharmacy network files
- Part C and D performance data — Star Ratings
Data vintage: 2026 plan-year data. CMS may revise files during the year.
Verify before enrolling: Confirm premiums, benefits, drugs, pharmacies, providers, eligibility, and service area with Medicare.gov Plan Compare or the plan. Read our methodology and editorial policy, or visit the Medicare plan FAQ.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
This is not a government website. This site is operated by Medicare Choose.