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Aetna Medicare Advantra Gold (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Gold (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Gold (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Gold (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern West Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Gold (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 Advantra Gold (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 Advantra Gold (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $9550.00 (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 $9550.00 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 Advantra Gold (PPO) plan has a $590 deductible for prescription drugs. After you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Advantra Gold (PPO) plan offers a range of benefits with varying cost-sharing. You'll have no copay for primary care, preventive services, home health services, and many outpatient services. The plan includes copays for inpatient hospital stays, outpatient services, emergency services, specialist visits, hearing and vision exams, and dental services. The plan covers services like hearing aids up to $500 per year and offers dental coverage with no copay up to $2,000 annually. You'll also find coverage for ambulance, home infusion, dialysis, and medical equipment with copays or coinsurance. Additional benefits include OTC items and meal benefits with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Aetna Medicare Advantra Gold (PPO) plan. For Inpatient Hospital-Acute, you will pay a $400 copay per admission for Medicare-covered stays, and no copay for additional days. For Inpatient Hospital Psychiatric care, you will pay a $325 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $225 copay, Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25.
Partial Hospitalization See details
Aetna Medicare Advantra Gold (PPO) covers partial hospitalization with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Advantra Gold (PPO). Ground ambulance services have a $275 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 are covered by Aetna Medicare Advantra Gold (PPO), with a $125 copay, and no coinsurance. Urgently Needed Services have a $45 copay, and no coinsurance, while Worldwide Emergency Services includes a $125 copay for Worldwide Emergency and Urgent Coverage and a $275 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $15 copay, but Routine Care is not covered. Occupational Therapy Services have a $20 copay. Physician Specialist Services have a copay between $0 and $25. Mental Health Specialty Services, including both individual and group sessions, have a $25 copay. Podiatry Services, including routine foot care, have a $25 copay. Other Health Care Professional services have a copay between $0 and $25. Psychiatric Services, including both individual and group sessions, have a $25 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
The Aetna Medicare Advantra Gold (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional services include 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, Kidney Disease Education Services and Other Preventive Services with no copay for Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Other services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Aetna Medicare Advantra Gold (PPO) covers hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, with no copay for all types except inner ear, outer ear, and over the ear, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $25, while 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, has no copay, with a combined maximum of $260 per year.
Dental Services See details
The Aetna Medicare Advantra Gold (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, as well as restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, up to a maximum of $2,000 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 Advantra Gold (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, though DME for use outside the home is not covered. Prosthetics and medical supplies are covered with a coinsurance, and diabetic equipment is covered with a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services, are covered. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $225, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Gold (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 not covered by the Aetna Medicare Advantra Gold (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Gold (PPO) plan with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional and non-Medicare covered SNF days are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture is not covered. OTC items have a maximum benefit of $50 every three months. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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