Aetna is the third largest Medicare Advantage insurer in America, and the one that publishes the least about its prices on its own website. Type a plan name into Aetna.com and you get a ZIP code box. No premium, no copay, no out-of-pocket maximum.
The numbers exist, though, in two places Aetna cannot hide them: CMS’s annual landscape file, which lists the premium and out-of-pocket cap for every plan in every county, and the Annual Notice of Change documents Aetna is required to post publicly each fall. This guide is built from both, for the 2026 plan year, and the picture they draw is not the one the marketing pages suggest.
What Is Aetna Medicare Advantage
Aetna Medicare Advantage is Part C coverage sold by Aetna, which has been owned by CVS Health since 2018. You keep Medicare, but Aetna administers your Part A and Part B benefits, usually bundles in Part D drug coverage, and adds extras Original Medicare does not cover. If the underlying structure is new to you, our parts of Medicare explainer is the place to start.
CVS Health holds 12% of national Medicare Advantage enrollment in 2026 according to KFF, third behind UnitedHealth Group at 26% and Humana at 20%. Nearly all of that sits under the Aetna Medicare brand: of 642 plan segments in the 2026 CMS file, 638 are marketed as Aetna Medicare.
The plan names are tiers, not plan types. Signature dominates at 223 plan segments, then Enhanced (65), Dual (51), Value (41), Chronic (38), Full (37), Elite (37), Eagle (35), Prime (30), and Advantra (28). One family behaves differently from the rest: Aetna Medicare Eagle plans carry no Part D drug coverage at all, which is why they show a lower premium and no drug deductible in CMS data.
How Aetna’s Plans Work
Aetna is a PPO-first carrier. The 2026 breakdown is 284 PPOs, 99 HMOs, 99 HMO-POS plans, 1 regional PPO, and roughly 160 special needs plans (111 dual-eligible, 44 chronic condition, 4 institutional). That PPO tilt is the single most useful thing to know about Aetna, because it changes the rules you live under.
Medicare.gov’s plan comparison spells out the difference. On an HMO you generally must use in-network providers except in an emergency, and you need a referral to see a specialist. On a PPO you can go out of network at a higher cost, and no referral is required. Aetna’s own 2026 Annual Notice of Change for Aetna Medicare Eagle Plus (PPO) puts it this way: your primary care provider may refer you to a specialist, but you can go to any specialist in the network without a referral.
The out-of-network door is not free. On that same Eagle Plus PPO, sold in Alabama, the primary care copay is $0 in network and $5 out, the specialist copay is $25 in network and $30 out, and an out-of-network inpatient stay costs 50% coinsurance. The in-network out-of-pocket maximum is $7,900. The combined in and out-of-network maximum is $13,900, which is exactly the ceiling CMS allows for 2026.
Prior authorization applies regardless of plan type. KFF found 99% of Medicare Advantage enrollees are in plans requiring it for at least some services in 2026, running to 97% for acute inpatient stays and 94% for Part B drugs. Read how prior authorization works before you need it, and know that a denial is appealable through the Medicare appeal process.
Service areas are county-level, so an “Aetna plan” in your ZIP code is a specific contract and plan number, not a national product. Aetna Medicare Signature Extra (HMO-POS), contract H1609-069, covers 67 counties in Iowa and nowhere else.
What It Costs
Every figure here is 2026 plan year. Ranges come from CMS’s CY2026 landscape file. The two named plans come from Aetna’s own Annual Notice of Change documents, and both were cross-checked against the CMS file, where the premiums, out-of-pocket maximums, and drug deductibles match to the dollar.
| 2026 cost item | Aetna range or figure | Notes |
|---|---|---|
| Monthly plan premium, individual plans | $0 to $204 | 67% of 483 individual plans are $0; median $0 |
| Monthly Part C (medical) premium alone | $0 to $181.20 | 91% of all Aetna plans charge $0 for the medical half |
| Monthly plan premium, special needs plans | $0 to $59 | Only 38% are $0; median $6 |
| Medicare Part B premium (you always pay this) | $202.90 | Standard 2026 rate, plus a $283 Part B deductible |
| In-network out-of-pocket maximum | $299 to $9,250 | Median $6,750 on individual plans, the highest of the big three |
| Part D drug deductible | $0 to $615 | 538 of 604 Aetna drug plans (89%) charge the full $615 |
| Aetna Medicare Signature Extra (HMO-POS), Iowa | $0 premium, $5,000 in-network cap | $0 primary care copay, $50 specialist, $615 drug deductible on tiers 3 to 5 |
| Aetna Medicare Eagle Plus (PPO), Alabama | $0 premium, $7,900 in-network cap | $0 primary care copay, $25 specialist, no drug coverage, $13,900 combined cap |
Three things stand out.
The drug deductible is the weak spot. Medicare.gov confirms that no Part D plan may charge a deductible above $615 in 2026. Aetna charges exactly that on 89% of its drug plans, a much higher share than Humana (59%) or UnitedHealthcare (29%) in the same data. Only 4 Aetna plans have no drug deductible at all. If you take brand-name medication, that $615 comes out of your pocket before the plan pays anything on tiers 3 through 5, and it counts toward the $2,100 annual out-of-pocket cap. Our Medicare Part D guide walks the payment stages.
Out-of-pocket maximums are higher than the competition. A median of $6,750 in network means half of Aetna’s individual plans expose you to more than that in a bad year, before drugs. KFF puts the 2026 industry average in-network limit at $5,421.
Costs moved a lot for 2026 on some plans. Aetna’s Annual Notice of Change for Signature Extra in Iowa shows the in-network out-of-pocket maximum going from $3,900 in 2025 to $5,000 in 2026, a 28% increase, and the specialist copay doubling from $25 to $50, while the premium held at $0. The Part D deductible on that plan rose from $590 to $615. The premium being unchanged tells you nothing about whether the plan got more expensive.
Who It’s Good For and Who Should Skip It
A good fit if you want a PPO without a referral gate. With 284 PPO plan segments in 2026, Aetna has the deepest PPO bench of the three largest carriers, and PPOs let you keep seeing a specialist without asking permission first.
A good fit if you use dental, vision, and hearing benefits. KFF found more than 99% of individual Medicare Advantage plans offer vision and 98% dental in 2026. Aetna’s plan-level allowances vary, and our Aetna dental insurance and Aetna vision insurance pages explain how the standalone products differ from the benefit built into a Medicare plan.
A good fit if you also have Medicaid. Aetna runs 111 dual-eligible special needs plan segments in 2026. Start with dual-eligible special needs plans before picking a general plan.
Think twice if you take expensive brand-name drugs. The $615 deductible on nearly every Aetna drug plan is the highest cost-sharing entry point in the market.
Think twice if a low out-of-pocket ceiling is your priority. Aetna’s median in-network cap runs above the industry average and above what Humana and UnitedHealthcare median at.
Think twice if you did not read this year’s Annual Notice of Change. The Iowa example above is exactly what happens when people renew on autopilot.
Aetna Medicare Advantage vs Original Medicare Plus Medigap
| Aetna Medicare Advantage | Original Medicare plus Medigap | |
|---|---|---|
| Monthly cost | $0 to $204 plan premium plus $202.90 Part B | $202.90 Part B plus a Medigap premium set by the insurer |
| Yearly out-of-pocket limit | Yes, $299 to $9,250 in network, median $6,750 | No federal limit, but Medigap absorbs most cost sharing |
| Provider choice | Plan network, county service area | Any provider that accepts Medicare, nationwide |
| Out-of-network care | Allowed on PPOs at higher cost, generally not on HMOs | Not a concept; any Medicare provider works |
| Referral to a specialist | Required on HMO plans, not on PPOs | Not required in most cases |
| Prior authorization | Required for certain services | Not required in most cases |
| Drug coverage | Built in on 604 of 642 plans, Eagle plans excepted | Separate Part D plan required |
| Dental, vision, hearing | Included on almost all plans | Not covered |
| Can you buy Medigap? | No | Yes, and best during your 6-month Medigap open enrollment window |
The comparison is not symmetric, and that is the part that costs people money. Enrolling in Aetna Medicare Advantage is easy during any Medicare open enrollment period. Leaving for Original Medicare plus Medigap later means applying for a Medigap policy outside your protected 6-month window, when insurers can decline you or charge more for your health history in most states.
Weigh it once, carefully, before you enroll. Our Medicare Advantage versus Medigap and Medicare Advantage versus Original Medicare guides lay out both sides.
The Bottom Line
Aetna’s 2026 Medicare Advantage lineup is PPO-heavy, mostly $0 premium, and carries the highest drug deductibles and the highest median out-of-pocket ceiling of the three biggest carriers. That combination suits someone who wants provider freedom and rarely fills a brand-name prescription, and suits someone with a large drug bill much less well.
Whatever plan you are considering, get the contract and plan number, then read Aetna’s Annual Notice of Change for that exact plan. It is public, it is free, and it is the only document that shows you what changed since last year. On the Iowa plan above, the answer was a 28% jump in your worst-case year and a doubled specialist copay behind an unchanged $0 premium.
One freshness note. This page reflects the 2026 plan year. CMS said in its July 28, 2026 Part D bid announcement that the 2027 Medicare Advantage and Part D landscape would publish in mid to late September 2026, ahead of the October 15 to December 7, 2026 enrollment window. Your 2027 Annual Notice of Change should arrive from Aetna before that window opens. Recheck your county before you renew, and compare against UnitedHealthcare, Anthem, Kaiser Permanente, Cigna, Wellcare, and Devoted Health while you are in there.