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Aetna Medicare Advantra Signature Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Signature Giveback (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 Signature Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Signature Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Advantra Signature Giveback (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 Signature Giveback (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 Signature Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $40.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1600.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $13900.00 (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 $13900.00 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 Signature Giveback (PPO) prescription drug plan features an annual drug deductible of $615. For generic medications, you can benefit from no copay on Tier 1 preferred generics and Tier 2 generics when utilizing a preferred pharmacy or preferred mail-order service. If you use a standard pharmacy or standard mail-order service, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications are subject to coinsurance under this plan rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy options. Additionally, Tier 5 specialty drugs are restricted to a maximum of a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Signature Giveback (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, annual physical exams, and wellness screenings. Specialist visits require a copay ranging from $0 to $55, while emergency room visits carry a $115 copay that is waived if you are admitted. For hospital care, inpatient stays require a $385 daily copay for the first seven days, while outpatient hospital services feature no coinsurance and copays ranging from $0 to $385. This plan also provides essential routine care, including select preventive dental cleanings and oral exams with no copay or coinsurance. Vision and hearing benefits offer routine exams at no copay alongside annual allowances for eyewear and prescription hearing aids. Additionally, home health services and cardiac rehabilitation are covered with no copay and no coinsurance, though prior authorization is required for certain services.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Advantra Signature Giveback (PPO) with no coinsurance, requiring a $385 copay for days 1 through 7 of acute stays and a $350 copay for days 1 through 5 of psychiatric stays, followed by no copay for remaining stay days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Advantra Signature Giveback (PPO) with no coinsurance across all services, including no copay for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $385, while observation services require a $385 copay per stay and outpatient substance abuse sessions carry a $50 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Signature Giveback (PPO) plan with copays ranging from no copay up to $110 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers emergency ambulance services with a $325 copay for ground transportation and a 20% coinsurance for air transportation, with prior authorization required. Routine transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency care and transportation are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $325.
Primary Care See details
Primary care services under the Aetna Medicare Advantra Signature Giveback (PPO) feature no copay and no coinsurance for primary care doctor visits, while specialist visits require a $0 to $55 copay and no coinsurance. Other benefits include physical and occupational therapy for a $35 copay and no coinsurance, telehealth for a $0 to $55 copay and 20% coinsurance, and partially covered chiropractic services for a $15 copay and no coinsurance, excluding routine and other chiropractic care.
Preventive Services See details
Preventive services under the Aetna Medicare Advantra Signature Giveback (PPO) are partially covered, featuring no copay and no coinsurance for annual physical exams, health education, and wellness screenings, though kidney disease education requires a 20% coinsurance and no copay. Services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services covered by Aetna Medicare Advantra Signature Giveback (PPO) include Medicare-covered exams for a $55 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services covered by the Aetna Medicare Advantra Signature Giveback (PPO) plan include routine eye exams with no copay and no coinsurance, up to a $50 annual maximum, and Medicare-covered exams with a $0 to $55 copay and no coinsurance. Eyewear, including lenses, frames, and contact lenses, is also covered with no copay or coinsurance up to a combined annual maximum of $100.
Dental Services See details
Aetna Medicare Advantra Signature Giveback (PPO) partially covers dental services, offering Medicare-covered dental care for a $55 copay and no coinsurance, alongside select preventive services with no copay and no coinsurance. Covered preventive care includes up to four oral exams, two cleanings, and one x-ray per year, while comprehensive treatments such as restorative, endodontics, periodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Signature Giveback (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Advantra Signature Giveback (PPO) with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices and diabetic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Advantra Signature Giveback (PPO) with prior authorization required. Diagnostic tests require between no copay and a $25 copay with no coinsurance, lab services have no copay or coinsurance, and radiological services range from a $50 copay for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Advantra Signature Giveback (PPO) with no copay and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Signature Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Aetna Medicare Advantra Signature Giveback (PPO), featuring no copay and no coinsurance for an annual wellness exam, screening mammography, and additional gFOBT and FIT tests. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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