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Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Missouri/Illinois. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Premier (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Aetna Medicare Premier (PPO)
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Drug Coverage
The Aetna Medicare Premier (PPO) plan has a $590 deductible for prescription drugs. Once you meet your deductible, your cost will vary depending on the drug tier and pharmacy you use. For preferred generic drugs, you have no copay when using a preferred pharmacy or preferred mail order. For standard generic drugs, you pay 24% coinsurance, and for preferred brand drugs, you pay 25% coinsurance.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive coverage with varying costs. For inpatient hospital stays, you'll pay a $310 copay for days 1-6, with no copay for the remainder of the stay. Outpatient services include a range of copays, from no copay to $275, depending on the specific service. Emergency services have a $110 copay, and primary care visits cost $5. Preventive services, such as an annual physical exam, have no copay. The plan also covers hearing, vision, and dental services, with varying copays and maximum benefits. Home health services, skilled nursing facilities (SNF), and medical equipment are covered with either no copay or a coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For days 1-6, the copay is $310, and there is no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a $310 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $30 copay for individual sessions and a $10 copay for group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, requiring prior authorization. You will have a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (PPO) plan. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Premier (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a copay between $0 and $45, and physical therapy and speech-language pathology services with a $25 copay. Mental health, psychiatric services, and opioid treatment program services have a copay between $10 and $30 depending on the service, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered with no copay for Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1500 per year, and have no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum benefit of $150 every year.
Dental Services See details
Dental services are covered with a $45 copay for Medicare dental services and a $500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (PPO) plan. This plan requires prior authorization, and has a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Premier (PPO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance. Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay ranging from $0 to $45, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $110, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for covered services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Aetna Medicare Premier (PPO) plan, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items and meal benefits are covered with no copay. Additional services such as annual wellness exam and screening mammography, and gFOBT, FIT are covered with no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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