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Aetna Medicare Premier Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wichita Kansas Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6200.00 (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 $6200.00 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 Plus (PPO)
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Drug Coverage
The Aetna Medicare Premier Plus (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. In the initial coverage phase, after the deductible, you will pay a $0 copay for preferred generic drugs at preferred pharmacies and mail order, and $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance depending on the specific drug and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay of $295 for the first six days, with no copay for days 7-90, and outpatient services have copays ranging from $0 to $300. Many services have no copay, including preventive services, eye exams, oral exams, and home health services. The plan provides coverage for emergency services, primary care, hearing, vision, and dental services, with specific copays and coinsurance amounts. Ambulance services have a copay of $280 for ground transport and 20% coinsurance for air transport. Other benefits include coverage for diagnostic and radiological services, home infusion, medical equipment, and skilled nursing facilities, with copays, coinsurance, and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $295 for days 1-6 and 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 and additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $300, and observation services with a $295 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $35 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier Plus (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier Plus (PPO) plan. Ground ambulance services have a $280 copay, while air ambulance services have a 20% coinsurance; however, 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 Plus (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Transportation has a $280 copay, while all services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $35 copay. It also covers physician specialist services with a copay between $0 and $35, and mental health specialty services with a $35 copay. Other covered services include podiatry services with a $35 copay, other health care professional services with a copay between $0 and $35, psychiatric services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $35, and opioid treatment program services with a $35 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while other services like Health Education, Nutritional/Dietary Benefit, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, and Fitness Benefit are covered with no copay. Kidney Disease Education Services have a 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Premier Plus (PPO) plan include hearing exams with a $35 copay, routine hearing exams with no copay for up to 1 visit per year, and fitting/evaluation for hearing aids with no copay for up to 1 visit per year. Prescription hearing aids are covered with a maximum benefit of $1500 per ear every year and no copay for up to 2 visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services, offered by Aetna Medicare Premier Plus (PPO), includes coverage for eye exams and eyewear. There is no copay for eye exams, including routine eye exams and other eye exam services, or for eyewear such as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services include Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, restorative services with 20% to 50% coinsurance, adjunctive general services with 20% to 50% coinsurance, endodontics with 20% coinsurance, periodontics with 20% to 50% coinsurance, prosthodontics (removable) with 50% coinsurance, and prosthodontics (fixed) with 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Premier Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a coinsurance between 0% and 20%, and Diabetic Equipment with a coinsurance between 0% and 20%; however, Durable Medical Equipment for use outside the home is not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $35, and lab services with no copay. Radiological services are also covered, with diagnostic services having a copay up to $160 and therapeutic services having 20% coinsurance, while outpatient X-rays have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus (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 not covered by the Aetna Medicare Premier Plus (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier Plus (PPO), but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Aetna Medicare Premier Plus (PPO) covers acupuncture with a $20 copay, and also covers over-the-counter (OTC) items with no copay, up to a maximum of $90 every three months. The plan also provides a meal benefit with no copay, and covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more.
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