Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026

Aetna Medicare Advantra Signature Giveback, 2027

H5522Contract017Plan

PPO · 62 counties in Pennsylvania

Run by Aetna Life Insurance Company (contract H5522), sold as Aetna Medicare, owned by CVS Health Corporation

Renews for 2027

2026 star rating, contract H5522: 4.5 of 5

Aetna Medicare Advantra Signature Giveback (H5522-017) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $9,850 ($9,250 in 2026).

What changes from 2026 to 2027?

The changed lines are marked and come first. In-network amounts; members keep paying the Part B premium unless the plan reduces it.
What you pay or get	2026	2027	Change
In-network out-of-pocket limit	$9,250	$9,850	up $600
Drug deductible	$615	$700	up $85
Part B premium reduction, monthly	$44	$42	down $2
Skilled nursing facility, in network	$0 a day for days 1–20, then $218 a day for days 21–100	$0 a day for days 1–20, then $221 a day for days 21–100	up $30for a 30-day stay
Over-the-counter items, yearly	$120 a year	$60 a year	down $60
Drug tier 1, preferred generic	$2	$5	up $3
Drug tier 3, preferred brand	24% of the cost	17% of the cost	down 7 points
Drug tier 4, non-preferred drug	25% of the cost	28% of the cost	up 3 points
13 lines do not change
Monthly premium	$0	$0	no change
Primary care visit	$0 copay	$0 copay	no change
Specialist visit	$50 copay	$50 copay	no change
Emergency room	$115 copay	$115 copay	no change
Medical deductible, in network	$950	$950	no change
Hospital stay, in network	$388 a day for days 1–7, then $0 a day for days 8–90	$388 a day for days 1–7, then $0 a day for days 8–90	no change
Ground ambulance, in network	$300 copay	$300 copay	no change
Comprehensive dental, yearly limit	$500 a year	$500 a year	no change
Eyewear, yearly limit	$100 a year	$100 a year	no change
Hearing aids, yearly limit for both ears	$500 a year	$500 a year	no change
Counties served	62	62	no change
Drug tier 2, generic	$12	$12	no change
Drug tier 5, specialty tier	25% of the cost	25% of the cost	no change

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.

What will prescriptions cost?

Your share for a 30-day supply at a retail pharmacy, as filed with CMS; tiers whose share changes are marked. The plan charges less at its preferred pharmacies
Tier	What the tier holds	2026, standard pharmacy	2027, standard pharmacy	2027, preferred pharmacy
Tier 1	Preferred Generic	$2	$5	$0
Tier 2	Generic	$12	$12	$5
Tier 3	Preferred Brand	24% of the cost	17% of the cost	17% of the cost
Tier 4	Non-Preferred Drug	25% of the cost	28% of the cost	28% of the cost
Tier 5	Specialty Tier	25% of the cost	25% of the cost	25% of the cost

Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.

How does it compare with plans sold where it is?

In the counties it serves, 185 plans open to everyone are sold for 2027, this one included. Against the others, 164 plans have a lower out-of-pocket limit, 20 the same. On the premium, 99 the same, 85 a higher one.

Out-of-pocket limits of the 185 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0001 plan

$4,000 to under $6,00045 plans

$6,000 to under $8,00094 plans

$8,000 to $10,000 (this plan)45 plans

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Where is it sold, and what does it cost there?

The premium and the out-of-pocket limit are the same in all 62 counties: $0 a month and $9,850.

Pennsylvania

Adams Allegheny Armstrong Beaver Bedford Berks Blair Bradford Bucks Butler Cambria Cameron Centre Chester Clarion Clearfield Clinton Columbia Crawford Cumberland Dauphin Delaware Elk Erie Fayette Forest Franklin Fulton Greene Huntingdon Indiana Jefferson Juniata Lackawanna Lancaster Lawrence Lebanon Luzerne Lycoming McKean Mercer Mifflin Montgomery Montour Northumberland Perry Philadelphia Pike Potter Snyder Somerset Sullivan Susquehanna Tioga Union Venango Warren Washington Wayne Westmoreland Wyoming York

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).

Who runs this plan?

Plan ID: H5522-017
Legal name of the contract: Aetna Life Insurance Company
Sold as: Aetna Medicare
Parent company: CVS Health Corporation
Plan type: PPO
2026 star rating of the contract: 4.5 of 5 overall; health plan 4.5 of 5, drug plan 4.5 of 5
Members, September 2026: 19,548
Plan website, as filed with CMS: www.aetna.com/medicare

Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.

What else should you check?

Other 2027 plans in Philadelphia, PAWhere most of its members live; premiums and limits side by side
Every Aetna Medicare plan for 2027Its contracts, counties and plans that end
The other 9 plans of contract H5522Same company, same contract
Is your prescription covered?Coverage share and tier for 2,259 drugs

Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.