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Aetna Medicare Premier Plus 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus 2 (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 2 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus 2 (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Topeka and surrounding areas. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Plus 2 (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 2 (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 2 (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 $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 2 (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies or standard mail order. Standard generic drugs have a 24% coinsurance, and preferred brand drugs and non-preferred drugs have a 25% coinsurance, regardless of pharmacy type. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus 2 (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. Preventive services, vision, and dental services are covered, often with no copay. This plan also includes benefits like home health services, hearing services, and medical equipment. You will pay a copay for some services, such as emergency services, primary care, and specialist visits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $310 copay for days 1-6, and no copay for days 7-90. The plan does not cover Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute. The plan also does not cover Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $350, 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
Aetna Medicare Premier Plus 2 (PPO) covers partial hospitalization with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $320 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 2 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $40 copay, with no coinsurance for either service. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $320 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier Plus 2 (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services, individual and group sessions for mental health and psychiatric services, podiatry services, and opioid treatment program services have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, and physician specialist services have a copay between $0 and $40. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Kidney Disease Education Services have a 20% coinsurance. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams have a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1,500 per year, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay, and a combined maximum of $160.00 is available every year for eyewear.
Dental Services See details
Dental Services are covered, including 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, all with no copay. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. There is a $2,000 maximum plan benefit coverage amount per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier Plus 2 (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered under the Aetna Medicare Premier Plus 2 (PPO) plan, with no copay. Durable Medical Equipment (DME) has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies and Diabetic Supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier Plus 2 (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Diagnostic radiological services have a copay of at most $160, while 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 Plus 2 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier Plus 2 (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 the Aetna Medicare Premier Plus 2 (PPO) plan. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Premier Plus 2 (PPO) plan covers acupuncture with a $20 copay, and it covers over-the-counter items with no copay. The plan also covers a meal benefit with no copay. Other services, including EPSDT services, private duty nursing services, and more, are not covered.
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