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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 SW MO / SE KS 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 $250.00 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 $8950.00 (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 $8950.00 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:
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Drug Coverage
The Aetna Medicare Premier Plus (PPO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, the copay is $10 at a preferred pharmacy and $12 at a standard pharmacy. For standard generic drugs, preferred and standard pharmacies will have 25% coinsurance. For preferred brand drugs, you will pay 26% coinsurance at either pharmacy, and for non-preferred drugs, you will pay 30% coinsurance.
Additional Benefits
The Aetna Medicare Premier Plus (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. Emergency and urgent care services are covered, and primary care visits have no copay. Preventive services like annual exams are covered with no copay, and there are also benefits for hearing, vision, and dental services. Hearing aids are covered up to $1500 per ear per year, and vision services have no copay for eye exams and eyewear. Dental services have a $2,000 annual maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $335 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $310 copay for days 1-6, and no copay for days 7-90; additional days are not covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include hospital services with a copay between $0 and $375, observation services with a $335 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Premier Plus (PPO). Ground ambulance services have a $350 copay, while air ambulance services have a 20% coinsurance. 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 have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $20 copay. Occupational Therapy Services, Physician Specialist Services, and Other Health Care Professional services are covered with copays ranging from $0 to $40. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay that ranges from $0 to $40. Podiatry Services are covered with a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Aetna Medicare Premier Plus (PPO) covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids up to $1500 per ear per year with no copay. Prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier Plus (PPO) plan covers vision services including eye exams and eyewear. Eye exams and eyewear have no copay, and routine eye exams are limited to one per year. Eyewear benefits have a combined maximum of $200 per year for both in and out-of-network services.
Dental Services See details
Dental Services has a $2,000 annual maximum benefit, and covers Medicare Dental Services with a $40 copay. 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 and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 under the Aetna Medicare Premier Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Premier Plus (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Medical Supplies have a coinsurance of 0% to 20%, and Diabetic Supplies have a coinsurance of 0% to 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Radiological services are also covered, with a copay for Medicare-covered diagnostic and therapeutic radiological services, and a coinsurance of at most 20% for therapeutic radiological services. Outpatient X-Ray services 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier Plus (PPO) plan, but the specific services are not covered. 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 the Aetna Medicare Premier Plus (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier Plus (PPO) plan covers acupuncture with a $20 copay, and over-the-counter items with no copay up to a $45 maximum benefit every three months. Meal benefits and other services like annual wellness exams and screening mammograms are covered with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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