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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 IL Chicago. 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 $44.00. 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 $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 $10100.00 (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 $10100.00 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 Premier (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when utilizing a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply fill. Brand-name and specialty medications under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs have a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail order channels. Please note that Tier 5 specialty medications are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, home health services, and annual preventive physicals. Specialist visits, outpatient services, and emergency care are covered with low copays and no coinsurance, while inpatient hospital stays require daily copays for the first seven days of your stay. Diagnostic lab services and outpatient X-rays are also available to members with no copay or coinsurance. For additional wellness needs, the plan provides routine vision and hearing exams with no copay, plus allowances for eyewear and prescription hearing aids. Preventive dental services carry no copay, while comprehensive dental care is covered with a 20% to 50% coinsurance up to a $2,000 annual limit. Members also receive a $30 quarterly over-the-counter allowance to help cover the cost of everyday health and wellness items.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1-7 of acute stays and a $250 daily copay for days 1-7 of psychiatric stays, followed by no copay for subsequent covered days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $300, observation services carry a $300 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of either $65.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Premier (PPO), requiring prior authorization for ground ambulance services at a $265 copay with no coinsurance, and air ambulance services at a 20% coinsurance with no copay. While transportation is listed as covered, some services are covered but trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $45 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays of either $130 or $265.
Primary Care See details
Aetna Medicare Premier (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $30 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $30 copay with no coinsurance, but chiropractic and podiatry services are not covered. Mental health, psychiatric, and opioid treatments have a $40 copay with no coinsurance, while telehealth benefits are available with a $0 to $45 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Premier (PPO) provides preventive services with no copay and no coinsurance for annual physicals, diabetes self-management, and select supplemental benefits, while kidney disease education has a 20% coinsurance and no copay. The benefit is partially covered, as in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Premier (PPO), offering Medicare-covered exams for a $30 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay or coinsurance. Up to two prescription hearing aids are covered with no copay or coinsurance up to a $750 maximum per ear every year, while OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no coinsurance and no deductibles, offering routine eye exams with no copay and Medicare-covered exams with a $0 to $30 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a $175 annual combined maximum.
Dental Services See details
Aetna Medicare Premier (PPO) partially covers dental services, offering preventive care with no copay and no coinsurance, and Medicare-covered dental for a $30 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Premier (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Part B insulin has a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Premier (PPO) with no copay for durable medical equipment, prosthetics, and diabetic therapeutic shoes, with coinsurance ranging from no coinsurance to 20% depending on the item. Prior authorization is required for durable medical equipment, prosthetics, medical supplies, and diabetic equipment.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and tests require a copay of up to $75 with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Premier (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Premier (PPO) plan with no coinsurance, although some services are covered while others are not in practice. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, with copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not needed, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Aetna Medicare Premier (PPO) partially covers other services, offering select benefits with no copay and no coinsurance, including an annual wellness exam, screening mammography, additional gFOBT and FIT screenings, and a $30 quarterly over-the-counter allowance. Acupuncture, meal benefits, and certain CMS over-the-counter list drugs are not covered.
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