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Aetna Medicare Preferred Premium (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred Premium (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Preferred Premium (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred Premium (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in GA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Preferred Premium (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 Preferred Premium (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 Preferred Premium (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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:
Sign up for Aetna Medicare Preferred Premium (PPO)
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Drug Coverage
The Aetna Medicare Preferred Premium (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail-order pharmacies, and a $12 copay at standard pharmacies and standard mail-order pharmacies. The plan then moves into the catastrophic coverage phase once your total yearly drug costs reach $2,000, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Preferred Premium (PPO) plan offers coverage for a variety of services with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have a mix of copays and no copays depending on the specific service. Emergency services have a copay, and ambulance services have a copay or coinsurance. Preventive services and dental services are available with no copay for many services, while vision services include no copay for eye exams and eyewear up to a limit. Additional benefits include hearing services, home health, and skilled nursing facility services with specific cost-sharing structures. Diagnostic and radiological services, dialysis services, and medical equipment have copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered. For Inpatient Hospital-Acute, you pay a $380 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you pay a $407 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Preferred Premium (PPO) plan. Outpatient Hospital Services have a copay of $0-$380, Observation Services have a $380 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Preferred Premium (PPO) plan, with a $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Preferred Premium (PPO) plan, including both ground and air ambulance services. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Preferred Premium (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay and Worldwide Emergency Transportation has a $295 copay.
Primary Care See details
The Aetna Medicare Preferred Premium (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay (prior authorization required), and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $5-$35 copay, individual and group mental health and psychiatric sessions with a $30 copay, physical therapy and speech-language pathology services with a $25 copay, and additional telehealth benefits with a 20% coinsurance and a $0-$45 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, including an annual physical exam with no copay. Additional preventive services such as health education, wigs for hair loss related to chemotherapy, smoking cessation, and fitness benefits are covered, but some have a copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per year, and all types of prescription hearing aids have no copay, while inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, and routine eye exams are covered with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $280 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Orthodontics and implant services are not covered, and there is a $1,750 annual maximum for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Preferred Premium (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a copay between $0 and $95, lab services have no copay, diagnostic radiological services have a copay up to $300, therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Preferred Premium (PPO) plan with no copay and no coinsurance, although 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 by the Aetna Medicare Preferred Premium (PPO) plan, but the plan does not cover the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Preferred Premium (PPO), but require prior authorization. You will pay no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for over-the-counter items with no copay, and a $120 allowance every three months. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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