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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 Southeast Missouri. 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 $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 $7000.00 (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 $7000.00 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 Premier Plus (PPO)
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Drug Coverage
The Aetna Medicare Premier Plus (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. In the initial coverage phase, after you pay the deductible, you will pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies, while standard pharmacies have a $12 copay. For other tiers, you will pay coinsurance of 24% or 25% depending on the drug. 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 (PPO) plan offers a wide range of benefits, including inpatient hospital stays with a $300 copay for the first six days and no copay thereafter, along with coverage for outpatient services, emergency services, and various doctor visits with varying copays. Preventive services such as annual physical exams, glaucoma screenings, and diabetes self-management training are covered with no copay. Additional benefits include coverage for hearing exams, vision services, and dental services with no copays for many services, as well as coverage for home health services, medical equipment, and skilled nursing facility stays. This plan also provides coverage for over-the-counter items and meals with no copay, making it a comprehensive option for those seeking robust healthcare coverage.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered with a $300 copay for days 1-6 and no copay for days 7-90; Inpatient Hospital Psychiatric services are also covered, with the same cost-sharing structure. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays 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, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $300, while observation services have a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40 and $30 respectively.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus (PPO) plan, but requires prior authorization. You will pay a $60 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier Plus (PPO) plan. Ground ambulance services have a $300 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 $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
Primary Care Physician Services have a $5 copay; Chiropractic Services have a $15 copay, but routine care is not covered; Occupational Therapy Services have a $40 copay; Physician Specialist Services have a copay between $0 and $40; Mental Health Specialty Services have a copay between $30 and $40, depending on the session type; Podiatry Services and Routine Foot Care have a $45 copay; Other Health Care Professional services have a copay between $0 and $40; Psychiatric Services have a copay between $30 and $40, depending on the session type; Physical Therapy and Speech-Language Pathology Services have a $40 copay; Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45; and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Aetna Medicare Premier Plus (PPO) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers kidney disease education services with 20% coinsurance, and various other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $1500 per year, and Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. 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, while eyewear has a combined maximum of $165 per year.
Dental Services See details
Dental services are covered, including 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. Medicare dental services have a $45 copay, and this plan covers up to $750 per year for both in-network and out-of-network services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Premier Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, and 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 include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for covered devices and supplies. Diabetic Equipment is covered, with a 0% to 20% coinsurance for Diabetic Supplies and a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $45, and lab services with no copay. Diagnostic radiological services have a copay of up to $110, while therapeutic radiological services have a coinsurance of at least 20%, and 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, but no specific services are covered. There is a copay for some services, but the specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Premier Plus (PPO). For days 1-20, the copay is $10, and for days 21-100, the copay is $214; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Premier Plus (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $45 every three months. The plan also covers meal benefits with no copay, and other services including annual wellness exams, screening mammography, gFOBT, and FIT with no copay. Acupuncture, 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 are not covered.
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