A non-government entity
Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for 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 Aetna Medicare Premier (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in District of Columbia. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that 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 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 Aetna Medicare Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $70.00. 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 $1200.00 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 $8500.00 (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 $8500.00 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 Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Premier (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will have no copay when filling prescriptions through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options require a copay starting at $2.00 for Tier 1 and $12.00 for Tier 2. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail-order services. Note that Tier 5 specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay and no coinsurance for primary care visits and annual preventive screenings. Specialist visits require a copay ranging from no copay up to $50 with no coinsurance, while emergency room visits carry a $115 copay. For inpatient hospital stays, members pay a $340 daily copay for the first eight days of acute stays with no coinsurance, while subsequent days are covered with no copay. This plan also includes essential ancillary benefits, providing routine dental, vision, and hearing exams with no copay and no coinsurance. Vision services feature no deductible alongside a $200 annual eyewear allowance, while hearing aids are covered up to $500 per ear annually with no copay. Additionally, members can access home health services with no copay and receive a $30 quarterly allowance for over-the-counter health items.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1-8 of acute stays and a $260 daily copay for days 1-8 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient services with no coinsurance, featuring a $0 to $340 copay for outpatient hospital services, a $340 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance, with no deductible required for blood services.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ground ambulance services with a $275 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Aetna Medicare Premier (PPO) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care requires a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Aetna Medicare Premier (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Therapy, mental health, and psychiatric services are covered with copays ranging from $30 to $40 and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered under Aetna Medicare Premier (PPO), with most services—including annual physicals and screenings—available with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, or counseling.
Hearing Services See details
Aetna Medicare Premier (PPO) covers hearing exams with a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Premier (PPO) with no deductible, no coinsurance, and copays ranging from $0 to $50 for eye exams, including one annual routine exam with no copay. Eyewear is also covered with no copay or coinsurance, up to a $200 combined annual maximum limit for both in-network and out-of-network contacts, lenses, and frames.
Dental Services See details
Dental services are partially covered by Aetna Medicare Premier (PPO), featuring no copay and no coinsurance for preventive services like exams and cleanings, and a $50 copay with no coinsurance for Medicare-covered dental. Comprehensive services have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum, though fluoride, implants, orthodontics, maxillofacial prosthetics, and certain diagnostic and preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Premier (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for diagnostic services alongside no copay for lab tests and a $0 to $100 copay for procedures. Radiological services require a minimum 20% coinsurance for therapeutic services, diagnostic radiological copays starting at $0, and no copay for outpatient X-rays which are subject to coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no copay and no coinsurance under the Aetna Medicare Premier (PPO) plan. However, only some services are covered in practice, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Premier (PPO) partially covers other services, offering no copay and no coinsurance for a chronic illness meal benefit, select wellness exams, and up to $30 every three months for over-the-counter items. Acupuncture is not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved