A non-government entity
Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for the 2025 plan year to people living in Central and East AR Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (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 (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 (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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7900.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $14000.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier. For preferred generic drugs, you pay no copay at preferred pharmacies or through mail order, and a $12 copay at standard pharmacies. For other tiers, you will pay 24% or 25% coinsurance. 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 (PPO) plan provides comprehensive coverage with a variety of benefits. This plan offers no copay for primary care visits, preventive services like annual physical exams, and vision services like eye exams and eyewear. It also includes no copay for dental diagnostic and preventive services. The plan includes copays for other services such as inpatient hospital stays, outpatient services, specialist visits, and emergency services. Additionally, this plan offers coverage for hearing exams, prescription hearing aids up to $500 per year, and home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, which require prior authorization. For Inpatient Hospital-Acute, there is a $380 copay for days 1-7 and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $407 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 Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered. Non-Medicare-covered Stay and Additional Days for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $380, observation services with a $380 copay, ambulatory surgical center (ASC) services with no copay, and outpatient substance abuse services with a $50 copay for both individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, requiring prior authorization and a copay of $80.
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 $350 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency services and worldwide emergency coverage have a $110 copay, urgently needed services have a $40 copay, and worldwide emergency transportation has a $350 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. The plan also covers physician specialist services with a $0-$30 copay, mental health specialty services with a $35 copay, and physical therapy and speech-language pathology services with a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a $0-$50 copay, and opioid treatment program services with a $35 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services have a copay, and some services like in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing services with the Aetna Medicare Premier (PPO) plan include hearing exams for a $30 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered up to $500 per year, while prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and there is a combined maximum of $375 per year for eyewear.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, and restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. Other services, such as maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan. The plan has a maximum benefit of $2,000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization, with coverage including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Premier (PPO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays for diagnostic procedures/tests ranging from $0 to $95. Lab services have no copay, while diagnostic radiological services have a copay of at most $300. 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 (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 covered by the Aetna Medicare Premier (PPO) plan, but the specific services are not covered. No copay or coinsurance information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan, 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 Premier (PPO) plan does not cover acupuncture, but covers over-the-counter items with no copay, a maximum benefit of $45 every three months, and covers nicotine replacement therapy and Naloxone. The plan also covers a meal benefit and other services such as annual wellness exams with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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