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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H5521-085 Cross-check on Medicare.gov →

Aetna Medicare Signature (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$615.00 Annual Deductible
1,055 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 RECOMBIVAX HB Hepatitis B Vaccine (Recombinant) Brand Tier 1 $0.00 Details
2 ISENTRESS RALTEGRAVIR Brand Tier 5 0.3% coinsurance Details
3 Ciprofloxacin Brand Tier 2 $0.00 Details
4 Doxepin Hydrochloride doxepin hydrochloride Brand Tier 4 0.3% coinsurance Details
5 Chlorpromazine Hydrochloride Brand Tier 4 0.3% coinsurance Details
6 Dexamethasone Brand Tier 4 0.3% coinsurance Details
7 Haloperidol Brand Tier 2 $0.00 Details
8 Ciprofloxacin Brand Tier 2 $0.00 Details
9 Rufinamide Brand Tier 5 0.3% coinsurance Details
10 BOSULIF Bosutinib Brand Tier 5 0.3% coinsurance Details
11 SCEMBLIX asciminib Brand Tier 5 0.3% coinsurance Details
12 Teflaro ceftaroline fosamil Brand Tier 5 0.3% coinsurance Details
13 PIQRAY alpelisib Brand Tier 5 0.3% coinsurance Details
14 Amoxapine Brand Tier 3 0.2% coinsurance Details
15 Clozapine Brand Tier 4 0.3% coinsurance Details
16 Pyridostigmine Bromide PYRIDOSTIGMINE BROMIDE Brand Tier 3 0.2% coinsurance Details
17 Combivent Respimat ipratropium bromide and albuterol Brand Tier 4 0.3% coinsurance Details
18 Tafinlar dabrafenib Brand Tier 5 0.3% coinsurance Details
19 Buspirone Hydrochloride Brand Tier 1 $0.00 Details
20 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 3 0.2% coinsurance Details

Showing 20 of 1,055 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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