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Aetna Medicare Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Freedom (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Freedom (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in RGV Region. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Freedom (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 Freedom (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 Freedom (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 Freedom (PPO) plan has an Enhanced Alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order pharmacies. For standard generic drugs, you will pay 24% coinsurance. For preferred brand and non-preferred drugs, you will pay 25% coinsurance.
Additional Benefits
The Aetna Medicare Freedom (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay for the first few days, but no copay thereafter, while outpatient services have copays depending on the service. Primary care visits, eye exams, and many preventive services have no copay, while other services like hearing exams and specialist visits have copays. The plan covers ambulance and emergency services with copays, and offers coverage for dental, vision, and hearing services with specific copays and coinsurance. Additionally, the plan provides coverage for home health services, skilled nursing facilities, and home infusion services, each with their own cost structure. The plan also offers coverage for medical equipment and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Aetna Medicare Freedom (PPO) plan covers outpatient services including outpatient hospital services with a copay between $0 and $250, observation services with a $300 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Freedom (PPO) plan, but requires prior authorization. The plan has a copay of $85 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Freedom (PPO) plan. Ground Ambulance Services have a $290 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Freedom (PPO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $55 copay and no coinsurance, while Worldwide Emergency Services have varying copays depending on the service.
Primary Care See details
The Aetna Medicare Freedom (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy has a $25 copay, and physician specialist services have a copay between $0 and $25. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $60.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services. The plan also covers kidney disease education services with 20% coinsurance. Other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay; prescription hearing aids are covered up to $1,000 per year, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare Freedom (PPO) plan. Eye exams and eyewear have no copay, and there is a combined maximum benefit of $305 per year for eyewear.
Dental Services See details
Dental Services offered by Aetna Medicare Freedom (PPO) include Medicare Dental Services with a $25 copay and oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance ranging from 20% to 50%.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Freedom (PPO) plan, requiring prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Freedom (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and 0-20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have 20% coinsurance, and Medical Supplies have 0-20% coinsurance. Diabetic Supplies have 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $50 for diagnostic procedures/tests, and lab services with no copay. Outpatient X-Ray services have no copay, while diagnostic radiological services have a copay up to $325, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. 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 Freedom (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Freedom (PPO) plan with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Freedom (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $45 every three months. Acupuncture, meal benefits, and several other services are not covered.
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