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Aetna Medicare Platinum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Platinum (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Platinum (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Platinum (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in North Dakota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Platinum (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 Platinum (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 Platinum (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:
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Drug Coverage
The Aetna Medicare Platinum (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. Once the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. Preferred Generic drugs have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Other tiers have 22% or 25% coinsurance. After your total yearly drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Platinum (PPO) plan offers a wide range of benefits, including inpatient and outpatient hospital services with varying copays, and no copay for many outpatient services. This plan also covers emergency services, primary care with no copay, and preventive services like annual physical exams, vision, and dental services. You'll also find coverage for hearing exams and hearing aids, as well as home health services with no copay. The plan includes copays for specific services, such as ambulance services, specialist visits, and some therapies. There is also coinsurance for air ambulance, dialysis services, and some medical equipment. Some services, like cardiac rehabilitation and additional days at a skilled nursing facility, are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered under the Aetna Medicare Platinum (PPO) plan. For Inpatient Hospital-Acute, you'll pay a $350 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric services have a $370 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
The Aetna Medicare Platinum (PPO) plan covers outpatient services, including outpatient hospital services with a copay ranging from $0 to $350, observation services with a $350 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services, including individual and group sessions, each with a copay between $40 and $40. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Platinum (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Platinum (PPO) plan, with a $370 copay for ground ambulance services and 20% coinsurance for air ambulance 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 Platinum (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125, $125, and $370 respectively, with a maximum plan benefit coverage of $150,000.
Primary Care See details
Primary Care Physician Services are covered with no copay, Chiropractic Services have a $20 copay, and Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $30 copay, while Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services all have a minimum copay of $40. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Other Health Care Professional services have a copay between $0 and $30. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $50. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Platinum (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay, as well as Kidney Disease Education Services with a 20% coinsurance. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Aetna Medicare Platinum (PPO) covers hearing exams with no copay, as well as Routine Hearing Exams and Fitting/Evaluation for Hearing Aids with no copay. Prescription hearing aids are covered up to a maximum of $1250 per year with no copay. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Platinum (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and there is a $200 combined maximum plan benefit for eyewear every year.
Dental Services See details
The Aetna Medicare Platinum (PPO) plan covers dental services with a $750 annual maximum benefit, including a $30 copay for Medicare dental services and no copay for oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, other preventative services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Platinum (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while 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 Platinum (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, including Diabetic Supplies with a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered with a copay of $0-$20 for diagnostic procedures/tests and no copay for lab services. Radiological services are covered, with a copay of up to $250 for diagnostic services, a coinsurance of up to 20% for therapeutic services, and a $10 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Platinum (PPO) plan with no copay and no coinsurance, but 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 Platinum (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 under the Aetna Medicare Platinum (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items and meal benefits with no copay, while acupuncture is not covered. The OTC benefit has a maximum coverage amount of $30 every three months. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many more are not covered.
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