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

Aetna Medicare Signature Giveback, 2027

H5522Contract022Plan

PPO · 15 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 Signature Giveback (H5522-022) costs $0 a month in 2027, the same as in 2026, with an in-network out-of-pocket limit of $7,150 ($6,750 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	$6,750	$7,150	up $400
Drug deductible	$615	$700	up $85
Part B premium reduction, monthly	$30	$26	down $4
Specialist visit	$50 copay	$45 copay	down $5
Medical deductible, in network	none	$950	added
Hospital stay, in network	$350 a day for days 1–7, then $0 a day for days 8–90	$375 a day for days 1–7, then $0 a day for days 8–90	up $125for a 5-day stay
Skilled nursing facility, in network	$10 a day for days 1–20, then $213 a day for days 21–100	$10 a day for days 1–20, then $221 a day for days 21–100	up $80for a 30-day stay
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
11 lines do not change
Monthly premium	$0	$0	no change
Primary care visit	$0 copay	$0 copay	no change
Emergency room	$130 copay	$130 copay	no change
Ground ambulance, in network	$290 copay	$290 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
Over-the-counter items, yearly	not offered	not offered	no change
Counties served	15	15	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, 92 plans open to everyone are sold for 2027, this one included. Against the others, 40 plans have a lower out-of-pocket limit, 11 the same, 40 a higher one. On the premium, 54 the same, 37 a higher one.

Out-of-pocket limits of the 92 plans open to everyone

$0 to under $2,0000 plans

$2,000 to under $4,0001 plan

$4,000 to under $6,00015 plans

$6,000 to under $8,000 (this plan)48 plans

$8,000 to $10,00028 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 15 counties: $0 a month and $7,150.

Pennsylvania

Adams Berks Carbon Cumberland Dauphin Franklin Juniata Lancaster Lebanon Lehigh Monroe Northampton Perry Schuylkill 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: H5522-022
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: 19,399
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 York, 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.