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Aetna Medicare Advantra Silver (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Silver (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 Silver (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Silver (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northeastern and Youngstown Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Silver (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 Silver (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 Silver (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:
Sign up for Aetna Medicare Advantra Silver (PPO)
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Drug Coverage
The Aetna Medicare Advantra Silver (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and where you get your prescriptions filled. For preferred generic drugs, you will have no copay if you use a preferred pharmacy or preferred mail order. For standard generic drugs, you will pay 24% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D drugs.
Additional Benefits
The Aetna Medicare Advantra Silver (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $275 copay for days 1-5, and no copay for days 6-90, while outpatient services have copays ranging from $0 to $250. Many services have no copay, including primary care visits, preventive services such as annual physical exams, vision and dental exams, and home health services. The plan also covers ambulance services with a $235 copay, and emergency services with a $100 copay. Hearing exams have a $30 copay, and hearing aids are covered up to a maximum benefit of $1250 per year. Additionally, the plan includes coverage for dental, home infusion, and medical equipment services with varying copays and coinsurance, and also provides an allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services, with a $275 copay for days 1-5, and no copay for days 6-90. 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.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay of $0 to $250, and observation services with a copay of $275. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Silver (PPO) plan with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Advantra Silver (PPO). Ground and Air Ambulance Services each have a $235 copay, and there is no coinsurance for these services. 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 Advantra Silver (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $100 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $235 copay, while all services have no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic services have a $20 copay. Occupational therapy services have a $40 copay with no coinsurance. Physician specialist services have a copay between $0 and $35. Mental health specialty services have a $40 copay for individual and group sessions. Podiatry services have a $30 copay. Other health care professional visits have a copay between $0 and $35. Psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay with no coinsurance. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Health education, wigs for hair loss, nutritional/dietary benefits, additional sessions of smoking cessation counseling, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit all have no copay. Kidney Disease Education Services have a 20% coinsurance. Some services, such as In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others, are not covered.
Hearing Services See details
Aetna Medicare Advantra Silver (PPO) covers hearing exams with a $30 copay, routine hearing exams, and fitting/evaluation for hearing aids with no copay; prescription hearing aids are covered with a maximum benefit of $1250 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year.
Vision Services See details
Aetna Medicare Advantra Silver (PPO) covers vision services, including eye exams with a copay of $0-$30 and eyewear with no copay and a combined maximum of $210 per year for both in-network and out-of-network services. Routine eye exams are covered with no copay, limited to one per year, and other eye exam services are covered with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and cleanings with no copay; however, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Silver (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 no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0-20% coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with 0-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $175, lab services with no copay, diagnostic radiological services with a copay up to $100, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $5 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Advantra Silver (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 Advantra Silver (PPO) plan. Specifically, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Advantra Silver (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Advantra Silver (PPO) plan covers Over-the-Counter (OTC) items with no copay, up to a maximum of $150 every three months. Acupuncture, Meal Benefit, 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 are not covered.
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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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