Aetna Medicare Prime (PPO) in Bergen County, New Jersey — 2026 plan details
Last updated Jul 18, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Aetna Medicare Prime (PPO) (H5521-392) is a $0-premium Medicare Advantage PPO from CVS Health Corporation available in Bergen County, New Jersey in 2026, with a 4.5-star overall rating, a $9,250 in-network out-of-pocket maximum, and a $615 annual Part D drug deductible.
Plan facts (CMS CY2026 Landscape file)
| Organization | CVS Health Corporation |
|---|---|
| Plan name | Aetna Medicare Prime (PPO) |
| Contract ID | H5521 |
| Plan ID | 392 |
| Segment ID | 0 |
| Contract year | 2026 |
| Contract category | MA-PD |
| Plan type | PPO |
| SNP | No |
| Monthly consolidated premium | $0.00 |
| Part C premium | $0.00 |
| Part D basic premium | $0.00 |
| Part D total premium | $0.00 |
| Annual Part D deductible | $615.00 |
| Maximum out-of-pocket (in-network) | $9250.00 |
| Overall star rating | 4.5 |
How this plan is structured
- $0 consolidated premium. A $0 or near-$0 consolidated premium does not remove the Part B premium — the standard 2026 Part B premium is $202.90 per month and still applies. See the 2026 Medicare Part B premium.
- PPO plan type. Plan-type rules determine in-network use and referrals. See how Medicare Advantage HMO and PPO plans differ.
- $9,250 in-network out-of-pocket maximum. The MOOP is the annual cap on what a member pays in-network for covered Part A and Part B services. See how the Medicare Advantage MOOP works.
- Service area = Bergen County. Medicare Advantage plans are sold by service area; moving out of the plan's service area triggers a Special Enrollment Period to switch plans. See how moving changes your Medicare options.
How it compares in Bergen County
The CMS CY2026 Landscape file lists 50 Medicare Advantage plans in Bergen County, New Jersey, of which 0 carry a 5.0-star overall rating and 25 have a $0 consolidated monthly premium. Consolidated premiums range from $0.00 to $172.00 per month, and in-network out-of-pocket maximums range from $4250.00 to $9250.00.
For the full county plan directory, see all Medicare plans in Bergen County, New Jersey.
How to verify your doctors take this plan
Network participation changes throughout the year; we hold no provider-network data, so verify directly with these three sources before you decide:
- Open the plan's official Medicare.gov page and use its provider-directory link: Medicare.gov Plan Finder — H5521-392.
- Call the plan (CVS Health Corporation) using the member-services number listed on that plan page and ask whether each doctor, hospital, and pharmacy is in-network for 2026.
- Get free, unbiased help from your State Health Insurance Assistance Program (SHIP) — see free unbiased Medicare help from SHIP.
What H5521-392 means
CMS assigns every Medicare Advantage and Part D offering a plan identifier made of three parts. In H5521-392, the leading H marks the contract type (H = Medicare Advantage / Part C contract), the four digits 5521 are the contract number issued to the organization, and the three-digit 392 is the plan benefit package under that contract. The segment ID 0 identifies the service-area segment within the plan (0 = the default single segment).
Frequently asked questions
Is Aetna Medicare Prime (PPO) an HMO or PPO?
Aetna Medicare Prime (PPO) is a PPO Medicare Advantage plan.
Does Aetna Medicare Prime (PPO) include prescription drug coverage?
Yes — Aetna Medicare Prime (PPO) is a Medicare Advantage plan with prescription drug coverage (MA-PD) and a $615.00 annual Part D drug deductible for 2026.
What is the maximum out-of-pocket cost for Aetna Medicare Prime (PPO)?
The 2026 in-network maximum out-of-pocket limit for Aetna Medicare Prime (PPO) is $9250.00, per the CMS CY2026 Landscape file.
What counties offer Aetna Medicare Prime (PPO) (H5521-392)?
Aetna Medicare Prime (PPO) (H5521-392) is offered in ten New Jersey counties: Bergen County, Hunterdon County, Mercer County, Monmouth County, Morris County, Passaic County, Somerset County, Sussex County, Union County, and Warren County.
Sources
- CMS, Plan Year 2026 Medicare Advantage & Part D Landscape source file (March 2026) — retrieved 2026-07-18. Overall star rating year: 2026.
- Medicare.gov Plan Finder — compare plans and enroll.