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 2026, please refer to our full plan details page.
Aetna Medicare Premier (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 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 $101.00. 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 $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:
Sign up for Aetna Medicare Premier (PPO)
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Drug Coverage
The Aetna Medicare Premier (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, the plan offers no copay for one-, two-, or three-month supplies filled through preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy and mail-order options. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, while specialist visits require a $30 copay. Inpatient hospital stays are covered with no coinsurance and a $400 copay per stay, whereas outpatient services feature no copay for ambulatory surgical centers and up to a $200 copay for hospital services. Emergency care is accessible with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For extra wellness needs, the plan provides routine dental cleanings, annual hearing exams, and routine vision exams with no copay or coinsurance. Eyewear is covered with no copay up to a $400 annual allowance, while comprehensive dental services are covered with a 20% to 50% coinsurance up to a $2,500 yearly limit. Members also enjoy a $90 quarterly over-the-counter allowance and fitness programs with no copay.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $400 copay per stay with unlimited additional days at no copay, while psychiatric stays require a $350 daily copay for days 1 to 5 and no copay for days 6 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Premier (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Patients will pay a $0 to $200 copay for outpatient hospital services, a $200 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization with no coinsurance, though prior authorization is required. Depending on the service, you will face either no copay or a $110 copay.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ambulance services with prior authorization, requiring a $300 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Premier (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency and urgent care are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $115 to $300.
Primary Care See details
Aetna Medicare Premier (PPO) offers primary care physician services with no copay and no coinsurance, while most specialist, therapy, and mental health services require a $30 copay and no coinsurance. Chiropractic benefits are partially covered, offering routine care for a $15 copay and no coinsurance but excluding other chiropractic services, while telehealth services carry a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Premier (PPO) provides partially covered preventive services, offering annual physicals, glaucoma screenings, and diabetes self-management training with no copay and no coinsurance, while kidney disease education has no copay but requires a 20% coinsurance. Supplemental benefits like fitness programs and chemotherapy wigs are covered with no copay and no coinsurance. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Premier (PPO) covers hearing services with no deductible, offering Medicare-covered exams for a $30 copay and no coinsurance, and annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual limit per ear, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no deductible and no coinsurance, featuring eye exams with a $0 to $30 copay and eyewear with no copay. Coverage includes a $50 annual limit for eye exams and a $400 yearly allowance for contacts and eyeglasses.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Premier (PPO), with Medicare-covered dental services requiring a $30 copay and no coinsurance, and preventive services like cleanings and exams available with no copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $2,500 annual limit, but other diagnostic services, fluoride, implants, orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copay and prior authorization required. Depending on the specific item, coinsurance ranges from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (PPO) covers diagnostic procedures, lab services, and diagnostic radiological services with no copay and no coinsurance. Outpatient X-rays require a $20 copay, therapeutic radiological services require a 20% coinsurance, and prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Aetna Medicare Premier (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered with no copay and no coinsurance under the Aetna Medicare Premier (PPO) plan, but in practice, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under the Aetna Medicare Premier (PPO) are partially covered with no copay and no coinsurance for eligible benefits, including a $90 quarterly over-the-counter allowance, chronic illness meals, and select wellness screenings. However, acupuncture is not covered under this plan.
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