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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.
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 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 $86.00. 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 $14000.00 (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 $14000.00 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 Premier (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 22% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers a wide range of benefits with varying cost-sharing options. Inpatient hospital stays have a copay per admission, while outpatient services may have copays depending on the specific service. Many services, such as primary care visits, preventive services, and home health services, are available with no copay. The plan includes coverage for emergency services, with a copay, as well as ambulance and transportation services. Vision, hearing, and dental services are also covered, with copays and coinsurance applying to certain services. The plan also covers medical equipment, diagnostic services, and skilled nursing facility stays, each with its own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $375 copay per admission for a Medicare-covered stay, and additional days are covered with no copay; for Inpatient Hospital Psychiatric, there is a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, and ambulatory surgical center services with no copay. Additionally, outpatient substance abuse services are covered with a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, with a $0 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare Premier (PPO) plan covers ambulance and transportation services, with prior authorization required for all ambulance services. Ground ambulance services have a $300 copay, while air ambulance services have a 20% coinsurance, and other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $110, and Worldwide Emergency Transportation has a copay of $300; all have no coinsurance. The copay for emergency services is waived if admitted to the hospital within 24 hours. Worldwide Emergency Services has a maximum benefit coverage of $150,000.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services are covered with a $30 copay and no coinsurance. Physician Specialist Services are covered with a copay between $0 and $30. Mental Health Specialty Services, including individual and group sessions, are covered with a $30 copay. Podiatry Services, including Routine Foot Care, are covered with a $30 copay. Other Health Care Professional services are covered with a copay between $0 and $30. Psychiatric Services, including individual and group sessions, are covered with a $30 copay. Physical Therapy and Speech-Language Pathology Services are covered with a $30 copay and no coinsurance. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a $30 copay.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, all with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance. Other covered services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay and are limited to one visit per year. Prescription hearing aids are covered with a maximum benefit of $500 per year, and prescription hearing aids (all types) are covered with no copay, limited to two visits per year. OTC hearing aids, and prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered.
Vision Services See details
The Aetna Medicare Premier (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Eyewear benefits have a combined maximum plan benefit coverage of $400 per year, and include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers Medicare Dental Services with a $30 copay, and other dental services including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. This plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics, and has coinsurance between 20% and 50% for restorative services, adjunctive general services, periodontics, and oral and maxillofacial surgery. The plan also has 20% coinsurance for endodontics, and 50% coinsurance for prosthodontics (removable and fixed).
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) plan. The plan requires prior authorization for this service and has a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, while medical supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Premier (PPO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $265, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have a $20 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, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. The copay for these services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier (PPO), but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
Under the Aetna Medicare Premier (PPO) plan, Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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