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Allina Health Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Allina Health 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 Allina Health Aetna Medicare Premier (PPO) in 2025, please refer to our full plan details page.
Allina Health Aetna Medicare Premier (PPO) is a PPO plan offered by Allina Health and Aetna Insurance Holding Company available for enrollment in 2025 to people living in Twin Cities Metro and Select MN Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Allina Health 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 Allina Health 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 Allina Health Aetna Medicare Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 $250.00 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 $3900.00 (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 $3900.00 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 Allina Health Aetna Medicare Premier (PPO)
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Drug Coverage
The Allina Health Aetna Medicare Premier (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, the copay is $10 at preferred pharmacies and $12 at standard pharmacies. For other tiers, you will pay coinsurance that varies from 25% to 30% depending on the drug. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Allina Health Aetna Medicare Premier (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $395 copay per admission, while outpatient services have copays that vary between $0 and $350. Many services have no copay, like primary care visits, routine hearing and eye exams, and many dental services. The plan also includes coverage for ambulance services, with a $300 copay for ground transport and 20% coinsurance for air ambulance. Other benefits include coverage for hearing aids, vision services, and dental services, with specific cost-sharing for each. There is also coverage for home health, skilled nursing facilities, and other services like acupuncture, with unique cost-sharing structures for each.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $395 per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while 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
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $350, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $25 copay for both Individual and Group Sessions, and Outpatient Blood Services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Allina Health Aetna Medicare Premier (PPO) plan with a $75 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Allina Health Aetna Medicare Premier (PPO) plan, requiring prior authorization. Ground ambulance services have a $300 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services, including routine care, have a $20 copay. Occupational Therapy Services have a $25 copay, while Physician Specialist Services have a copay between $0 and $25. Mental Health Specialty Services have a $25 copay for individual and group sessions. Podiatry Services have a $25 copay for Medicare-covered services and routine foot care. Other Health Care Professional services have a copay that ranges from $0 to $25, while Psychiatric 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 that ranges from $0 to $25. Opioid Treatment Program Services have a $25 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, some of which require a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, such as Glaucoma Screening, have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $750 per ear every year, and all types of prescription hearing aids are covered with no copay. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams, with a copay between $0 and $25, and eyewear, with no copay. Routine eye exams are covered with no copay for one visit every year, while other eye exam services are covered with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $200 per year.
Dental Services See details
Dental services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. You will pay a $25 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Allina Health Aetna Medicare Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Allina Health Aetna Medicare Premier (PPO) plan. Durable medical equipment has a coinsurance of 0-20% and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance of 0-20%. Diabetic supplies have a coinsurance of 0-20%, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures and tests, and lab services. Diagnostic procedures and tests have a copay between $0 and $20, while lab services have no copay. Radiological services are also covered, with a copay of up to $125 for diagnostic services and a coinsurance of up to 20% for therapeutic services. Outpatient X-ray services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the Allina Health Aetna Medicare Premier (PPO) plan 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 covered, but not the specific services of 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. The copay for these services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20 and days 40-100, but there is a $214 copay for days 21-39.
Other Services See details
Other Services includes acupuncture with a $20 copay, and over-the-counter items with no copay, up to $60 every three months. The plan also covers a meal benefit with no copay, as well as annual wellness exams and screening mammograms with no copay, and gFOBT and FIT tests with no copay. However, the plan does not cover 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.
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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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