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Aetna Medicare Explorer Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer 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 Explorer Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Connecticut. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Explorer 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 Explorer 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 Explorer Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $66.00. 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 $10000.00 (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 $10000.00 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 Explorer Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, you will have no copay for preferred generic drugs at preferred pharmacies and preferred mail order, but pay a 24% coinsurance for standard generic drugs. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, costing you $31.30.
Additional Benefits
The Aetna Medicare Explorer Premier (PPO) plan offers comprehensive coverage with a focus on outpatient and primary care services. Many preventive services are available with no copay, including annual physical exams, and routine hearing and vision exams. This plan includes coverage for inpatient hospital stays, emergency services, and a range of therapies, such as physical and occupational therapy. It also provides benefits for home health services, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital coverage under the Aetna Medicare Explorer Premier (PPO) plan includes Inpatient Hospital-Acute, with a copay of $395 for days 1-6 and no copay for days 7-90. Inpatient Hospital Psychiatric is also covered, with a copay of $385 for days 1-5 and no copay for days 6-90; however, additional days and non-medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Explorer Premier (PPO) plan, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$275, Observation Services have a copay of $395, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Explorer Premier (PPO) plan, but requires prior authorization. You will pay a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer Premier (PPO) plan. Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a 20% coinsurance; however, 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 Explorer Premier (PPO) plan. Emergency Services has a $125 copay with no coinsurance, Urgently Needed Services has a $45 copay with no coinsurance, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
Under the Aetna Medicare Explorer Premier (PPO) plan, primary care services, chiropractic services (except for routine care), occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered. Primary care physician services have a $5 copay, chiropractic services have a $15 copay, occupational therapy services have a $40 copay, physician specialist services have a copay between $0 and $45, mental health specialty services have a $40 copay, other health care professional services have a copay between $0 and $45, psychiatric services have a $40 copay, physical therapy and speech-language pathology services have a $40 copay, additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and other services such as Health Education, Nutritional/Dietary Benefit, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing Services include Hearing Exams with a $45 copay, Routine Hearing Exams with no copay, Fitting/Evaluation for Hearing Aids with no copay, and Prescription Hearing Aids (all types) with a maximum copay of $1700, while 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
The Aetna Medicare Explorer Premier (PPO) plan covers vision services, including eye exams with a copay of $0-$45, and eyewear with a $200 combined maximum benefit per year and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams have no copay, and are covered once per year.
Dental Services See details
Dental services include a $45 copay for Medicare dental services, and no copay for oral exams, dental x-rays, and prophylaxis (cleaning). Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, fixed prosthodontics, oral and maxillofacial surgery, and orthodontics are not covered.
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 covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Explorer Premier (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), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $45, lab services with no copay, diagnostic radiological services with a copay up to $200, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Explorer 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 by the Aetna Medicare Explorer Premier (PPO) plan, but the specific services listed are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Explorer Premier (PPO) plan, but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare coverage and non-Medicare covered stays are not covered.
Other Services See details
The Aetna Medicare Explorer Premier (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $45.00 every three months. The plan also covers Meal Benefit and Other 1 and Other 2 services 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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