Allina Health Aetna Medicare Premier (PPO) Medicare Advantage Plan H3219-003 • 2027
- Monthly Premium
- $97.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4450.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $300.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 6,785 beneficiaries
Allina Health Aetna Medicare Premier (PPO) Introduction
Allina Health Aetna Medicare Premier is a Medicare Advantage PPO plan offered by Allina Health Aetna Medicare. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $97.00 monthly premium, $0.00 medical deductible, and $4450.00 in-network maximum out-of-pocket. CMS Plan ID H3219-003 identifies this plan. The 2027 Part D prescription drug deductible is $300.00.
Plan Benefits
Allina Health Aetna Medicare Premier has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H3219-003.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Specialist | In-network: $40 copay Out-of-network: 50% coinsurance |
In-network: $0-$30 copay Out-of-network: 50% coinsurance |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay |
| Telehealth benefit | In-network: $0-$40 copay, 20% coinsurance | In-network: $0-$30 copay, 20% coinsurance |
| Routine chiropractic | In-network: $20 copay Out-of-network: 50% coinsurance |
In-network: $20 copay Out-of-network: 50% coinsurance |
| Fitness benefits | Coming soon | In-network: $0 copay Out-of-network: 0% coinsurance |
| Health education | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | Not covered |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $0-$175 copay Out-of-network: 50% coinsurance |
In-network: $0-$100 copay Out-of-network: 50% coinsurance |
| Lab services | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Outpatient x-rays | In-network: $25 copay Out-of-network: 50% coinsurance |
In-network: $15 copay Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures | In-network: $0-$30 copay Out-of-network: 50% coinsurance |
In-network: $0-$30 copay Out-of-network: 50% coinsurance |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $150 copay |
| Worldwide emergency care | Coming soon | $150 copay |
| Urgent care | $40 copay | $30 copay |
| Inpatient hospital care | In-network: Tier 1 $275 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $350 per stay Out-of-network: 50% per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 Out-of-network: 50% per stay |
In-network: Tier 1 $0 per day for days 1-20 $218 per day for days 21-37 $0 per day for days 38-100 Out-of-network: 50% per stay |
| Ground ambulance | In-network: $295 copay Out-of-network: $295 copay |
In-network: $295 copay Out-of-network: $295 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $30 copay Out-of-network: 50% coinsurance |
In-network: $30 copay Out-of-network: 50% coinsurance |
| Outpatient group therapy | In-network: $30 copay Out-of-network: 50% coinsurance |
In-network: $30 copay Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care | In-network: Tier 1 $275 per day for days 1-5 $0 per day for days 6-90 $0 per stay Out-of-network: 50% per stay |
In-network: Tier 1 $350 per stay Out-of-network: 50% per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $40 copay Out-of-network: 50% coinsurance |
In-network: $30 copay Out-of-network: 50% coinsurance |
| Occupational therapy | In-network: $40 copay Out-of-network: 50% coinsurance |
In-network: $30 copay Out-of-network: 50% coinsurance |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Durable medical equipment | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Prosthetics | In-network: 20% coinsurance Out-of-network: 50% coinsurance |
In-network: 20% coinsurance Out-of-network: 50% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
In-network: 0%-20% coinsurance Out-of-network: 50% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Dental x-rays | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Cleaning | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Periodontics | In-network: 30% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Endodontics | In-network: 30% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Restorative services | In-network: 30% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 30% coinsurance Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: 0% coinsurance |
| Contact lenses | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Upgrades | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Fitting/evaluation | In-network: $0 copay Out-of-network: 50% coinsurance |
In-network: $0 copay Out-of-network: 50% coinsurance |
| Prescription hearing aids | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | In-network: $0 copay Out-of-network: $0 copay |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Allina Health Aetna Medicare Premier as a Part B benefit.
Prescription Drug Coverage
Allina Health Aetna Medicare Premier includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $56.10 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $56.10 |
| Low-Income Premium Subsidy: | $24.60 |
| Low-Income Premium Subsidy Paid by CMS: | $24.60 |
| Low-Income Subsidy Premium: | $31.50 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $300.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Allina Health Aetna Medicare starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Allina Health Aetna Medicare Premier may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | 18% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H3219)
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Allina Health Aetna Medicare
- Website
- Allina Health Aetna Medicare Plan Page
- Providers
- Allina Health Aetna Medicare Providers Page
- Formulary
- Allina Health Aetna Medicare Formulary Page
- Pharmacy
- Allina Health Aetna Medicare Pharmacy Page
- New Member Health Plan Help
- (844)622-5862
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)622-5862
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Allina Health Aetna Medicare Premier (H3219-003-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Allina Health Aetna Medicare Premier (PPO)
How much does plan H3219-003 cost per month?
The plan’s monthly premium is $97.00 for 2027. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $4450.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for Allina Health Aetna Medicare Premier?
The 2027 CMS star rating for Allina Health Aetna Medicare Premier is ★0.0 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 6,785 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $300.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Allina Health Aetna Medicare (official source) | http://www.AllinaHealthAetnaMedicare. | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Explore your Medicare coverage options | 25 May, 2025 |
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