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Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Houston and Surrounding Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $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 Signature (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, coverage transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance across all pharmacy options. Specialty tier medications are limited to a one-month supply under this plan.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust coverage with no copay and no coinsurance for primary care doctor visits, annual physicals, and routine home health services. For specialized care, specialist visits range from no copay up to a $70 copay, while emergency room visits require a $130 copay that is waived if you are admitted. Inpatient hospital stays require a daily copay for the first six days, followed by no copay for the remainder of your stay, all with no coinsurance. Routine dental, vision, and hearing exams are highly accessible with no copays, though some advanced services or hardware may require copays, coinsurance, or have annual coverage limits. Outpatient services and diagnostic tests generally feature no coinsurance, with copays ranging from no copay up to $400 depending on the specific service. Most medical equipment and dialysis services require a 20% coinsurance, helping you plan for predictable out-of-pocket costs.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a copay of $450 per day for days 1 to 6 of acute stays and $390 per day for days 1 to 6 of psychiatric stays, followed by no copay for days 7 to 90. Additional acute days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copays. Outpatient hospital services feature no coinsurance and a copay ranging from no copay to $400, while observation services require a $450 copay per stay and outpatient substance abuse sessions carry a $50 copay, both with no coinsurance.
Partial Hospitalization See details
The Aetna Medicare Signature (PPO) plan covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services under Aetna Medicare Signature (PPO) require prior authorization and are covered with a $310 copay and coinsurance for ground transport, and a 20% coinsurance and copayment for air transport. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum limit with no coinsurance, carrying copays of $130 for emergency or urgent care and $310 for emergency transportation.
Primary Care See details
Aetna Medicare Signature (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits have a $0 to $70 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care, while podiatry services are not covered.
Preventive Services See details
Preventive services under the Aetna Medicare Signature (PPO) are partially covered, offering no copay and no coinsurance for annual physical exams, health education, and various screenings, while kidney disease education has no copay but requires a 20% coinsurance. Several supplemental benefits are not covered under this plan, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing services, featuring a $70 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $500 annual maximum per ear, but OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance for routine eye exams and eyewear, including contacts and eyeglasses. This benefit has no deductible, offering up to $50 annually for exams and a combined $100 yearly allowance for eyewear.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Signature (PPO) plan, featuring Medicare-covered dental care for a $70 copay and no coinsurance, as well as routine exams, cleanings, and X-rays with no copay and no coinsurance. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (PPO) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays and coinsurance ranging from no coinsurance to 20% for durable medical equipment, medical supplies, and diabetic supplies. Prosthetic devices carry a 20% coinsurance, diabetic therapeutic shoes and inserts have no copay, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Aetna Medicare Signature (PPO) plan, with prior authorization required for all services. Lab services and outpatient X-rays feature no copay, diagnostic tests range from a $0 to $50 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Signature (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (PPO) with no coinsurance, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not needed, but additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, providing an annual wellness exam, screening mammography, and additional gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter items, and meal benefits 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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