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Aetna Medicare Premier 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier 2 (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 2 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier 2 (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in OH & KY. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier 2 (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 2 (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 2 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $79.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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 2 (PPO)
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Drug Coverage
The Aetna Medicare Premier 2 (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, with costs varying for other tiers and pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier 2 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay after the 6th day, and outpatient services have copays ranging from $0-$200. The plan also includes coverage for emergency, primary care, preventive, hearing, vision, and dental services, with some services having no copay and others with copays or coinsurance. Additional benefits include coverage for ambulance, home health, and skilled nursing facility services, with specific copays or coinsurance. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services, with some requiring prior authorization. However, it's important to note that certain services like cardiac rehabilitation, and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $285 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you also pay a $285 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $200, and observation services with a $285 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $40 copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier 2 (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier 2 (PPO) plan. Ground and Air Ambulance Services have a $255 copay, with no coinsurance, while 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. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $255 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Premier 2 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a $0-$35 copay, mental health specialty services, podiatry services with a $40 copay, and other health care professional services with a $0-$35 copay. Additionally, the plan covers psychiatric services, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a $0-$50 copay, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services are covered by the Aetna Medicare Premier 2 (PPO) plan. Annual physical exams, Health Education, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay, while Kidney Disease Education Services have a 20% coinsurance. Other preventive services are covered, but some services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and others are not covered.
Hearing Services See details
The Aetna Medicare Premier 2 (PPO) plan covers hearing exams with a $40 copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are covered up to $1250 per ear per year, with no copay for all types, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier 2 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams and other eye exam services have no copay, while eyewear has no copay with a combined maximum of $160 per year.
Dental Services See details
Dental services include a $1,500 annual maximum benefit, with no copay for services such as oral exams, dental x-rays, and other diagnostic and preventive services. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 by the Aetna Medicare Premier 2 (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. Durable Medical Equipment has a coinsurance between 0% and 20%, and medical supplies have a coinsurance between 0% and 20%. Diabetic supplies have a coinsurance between 0% and 20%, and there is no copay for diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $150, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier 2 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered under this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier 2 (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier 2 (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Aetna Medicare Premier 2 (PPO) plan, acupuncture, meal benefits, 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. Over-the-counter items and other services have no copay.
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