Plan H1608-027-0: Aetna Medicare Advantra Gold (PPO) – 2025 Coverage Details
This page provides coverage, cost, and availability details for Aetna Medicare’s H1608-027-0 Medicare Advantage plan for 2025.
*CMS rated this Aetna Medicare plan (H1608-027-0) 4 (Good) out of 5 stars.
Aetna Medicare Advantra Gold Basic Plan Details
- Plan ID
- H1608-027-0
- Plan Type
- PPO
- Plan Year
- 2025
- Premium
- $12.00/mo
Plus your Medicare Part B premium. - Health Plan Deductible
- $0.00
- Out-of-Pocket Maximum
- 5,500.00 /yr (in-network)
- Part B Reduction
- $0.00/mo
- Drug Plan Benefit
- Enhanced, $590.00 deductible
- Supplemental Benefits
- Vision, Hearing
- Availability
- See List
- Insured By
- Aetna Medicare
| Summary of Benefits |
|---|
Health Plan Out-of-Pocket Costs
This Aetna Medicare Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H1608-027-0.
NOTE: Certain preventive services are covered 100% by the plan as a Part B benefit.
Doctor's Office Visits
- Primary
- $0 Copay
- Specialist
- $25 Copay
Emergency, Urgent, and Inpatient Hospital Coverage
- Emergency room care
- $125 Copay
- Urgent care
- $45 Copay
- Ground ambulance
- $275 Copay
- Inpatient hospital care
- $400.00 per stay
- Skilled Nursing Facility
- $10.00 per day for days 1 through 20
$214.00 per day for days 21 and beyond
Foot Care
- Foot Exams and Treatments (Medicare-covered)
- $25 Copay
- Routine Foot Care
- $25 Copay
Chiropractic Care
- Medicare-covered chiropractic
- $15 Copay
- Routine chiropractic
- Not Covered
Mental Health Services
- Outpatient individual therapy
- $25 Copay
- Outpatient group therapy
- $25 Copay
- Inpatient psychiatric hospital care
- $325.00 per day for days 1 through 5
$0.00 per day for days 6 and beyond
Rehabilitation Services
- Physical therapy and speech and language therapy
- $20 Copay
- Occupational therapy
- $20 Copay
Medical Equipment and Supplies
- Diabetes supplies
- 20% Coinsurance
Prior Authorization Required - Durable medical equipment
- 20% Coinsurance
Prior Authorization Required - Prosthetics
- 20% Coinsurance
Diagnostics, Lab Services, and Imaging
- Diagnostic radiology services
- $225 Copay
Prior Authorization Required - Lab services
- $0 Copay
Prior Authorization Required - Outpatient x-rays
- $10 Copay
Prior Authorization Required - Diagnostic tests and procedures
- $0 Copay
Prior Authorization Required
Medicare Part B Drugs
- Chemotherapy
- 20% Coinsurance
- Other Part B drugs (Medicare-covered)
- 20% Coinsurance
Dental Services
- Medicare Covered Preventive Dental
- $25 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
- Maximum dental benefit
- $2,000.00 (Every year)
Hearing Aids and Services
- Fitting/evaluation
- Covered
Limits may apply - Hearing aids
- Not Covered
- Hearing exam
- Covered
Limits may apply
Vision Services
- Medicare-covered eye exam
- $ to $25 Copay
- Routine eye exam
- $0 Copay
1 Every year - Eyewear benefits
- None
Get a copy of the Aetna Medicare Advantra Gold Summary of Benefits.
Prescription Drug Costs & Benefits
Aetna Medicare Advantra Gold includes enhanced benefit Medicare Part D. Enhanced benefits offer greater coverage than basic, typically providing lower cost-sharing, broader drug coverage, and additional benefits, such as covering drugs not included in the standard formulary. These plans usually have higher premiums due to the extra coverage and flexibility they provide, but they cover a larger percentage of overall drug costs.
As of 2023, approximately 75% of people on Medicare are enrolled in enhanced plans.
Prescription Drug Premium with Extra Help
Extra Help is a Social Security program that helps people with limited income and resources lower or cut Part D costs. The following table outlines premium assistance details with Extra Help.
| Low Income Premium Subsidy: | ${part_d_lips_amount} |
|---|---|
| Low Income Premium Subsidy CMS Pays: | $12.00 |
| Low Income Subsidy Premium: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Deductible
The Medicare Part D annual deductible with this plan is $590.00. You must pay this amount at the pharmacy before Aetna Medicare begins paying its share.
Prescription Drug Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Aetna Medicare Advantra Gold has out-of-pocket costs you must pay when you pick up your prescriptions.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic* | $0.00 | $2.00 |
| Generic* | $0.00 | $12.00 |
| Preferred Brand | 24.00% | 24.00% |
| Non-Preferred Drug | 25.00% | 25.00% |
| Specialty Tier | 25.00% | 25.00% |
| *The Part D deductible does not apply. | ||
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join Aetna Medicare Advantra Gold .
| CMS Measure | Star Rating |
|---|---|
| 2025 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 |
Plan Availability
Aetna Medicare Advantra Gold (H1608-027-0) is available in the following locations (click to open):
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- H1608-050-0: Aetna Medicare Elite (PPO)
- H1608-105-0: Aetna Medicare Premier Plus (PPO)
- H1608-038-0: Aetna Medicare SmartFit (PPO)
- H1608-081-0: Aetna Medicare Platinum (PPO)
- H1608-028-0: Aetna Medicare Advantra Preferred (PPO)
- H1608-040-0: Aetna Medicare Advantra Value (PPO)
- H1608-073-0: Aetna Medicare Premier (PPO)
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Us About Aetna Medicare
| Website: | Aetna Medicare Plan Page (opens in new tab) |
|---|---|
| Providers: | Aetna Medicare Providers Page (opens in new tab) |
| Formulary: | Aetna Medicare Formulary Page (opens in new tab) |
| Pharmacy: | Aetna Medicare Pharmacy Page (opens in new tab) |
| 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 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Aetna Medicare, http://www.aetnamedicare.com, Last Accessed March 1, 2025
- Medicare.gov, "Medicare Advantage Plans cover all Medicare services", Last Accessed February 20, 2024
- Medicare.gov, "Your Medicare coverage choices", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed March 19, 2025
- CMS.gov, Landscape Source Files, Last Accessed March 15, 2025
- CMS.gov, Medicare Part C & D Performance, Last Accessed March 15, 2025
- CMS.gov, Plan Benefits Package,Last Accessed March 15, 2025
Research Note: This content is based on independent analysis of CMS data by David Bynon, Medicare analyst and founder of MedicareWire.
For details on how this plan was analyzed and constructed using CMS data, see our Medicare Plan Research Methodology.
Disclaimer: MedicareWire does not endorse or rank Medicare plans. Plan information is provided for educational and research purposes only and may not reflect the most current data available from CMS or the plan provider.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.