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 Select Counties in OH & KY. 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 $95.00. 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 $500.00 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 $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:
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Drug Coverage
The Aetna Medicare Premier (PPO) plan features a $500 prescription drug deductible and offers competitive cost-sharing options for generic medications. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when filling your prescriptions through a preferred pharmacy or preferred mail order service. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays across all pharmacy types. You will pay a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty medications require a 27% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive medical coverage with predictable cost-sharing and no coinsurance for many key services. Members enjoy no copay and no coinsurance for primary care visits, routine physicals, and home health services, while specialist visits require a copay of up to $40. For hospital care, inpatient stays feature a $285 daily copay for the first six days and no copay thereafter, while outpatient services range from no copay to a $285 copay with no coinsurance. This plan also includes valuable supplemental benefits to help manage your everyday healthcare expenses. Routine dental and vision services feature no copay or coinsurance, including a $1,000 annual dental maximum and a $150 allowance for eyewear. Additionally, members receive coverage for up to two prescription hearing aids per year with no copay and a $90 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $285 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Premier (PPO) with no coinsurance across all services, including ambulatory surgical center and blood services which also require no copay. Outpatient hospital services have a copay of $0 to $285, observation services require a $285 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance services under the Aetna Medicare Premier (PPO) require prior authorization, charging a $255 copay (with no coinsurance) for ground transport and a 20% coinsurance (with no copay) for air transport. While transportation services are technically covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Premier (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum limit with no coinsurance, featuring copays of $130 for emergency or urgent care and $255 for emergency transportation.
Primary Care See details
Aetna Medicare Premier (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and podiatry services require copays up to $40 and no coinsurance. Chiropractic services are not covered under this plan, but telehealth benefits are available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive services under Aetna Medicare Premier (PPO) are partially covered, offering no copay and no coinsurance for annual physicals, diabetes self-management, and fitness benefits. Kidney disease education is covered with a 20% coinsurance and no copay. Uncovered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Premier (PPO), featuring annual routine exams and fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $40 copay and no coinsurance. Up to two prescription hearing aids are covered yearly with a $1,250 maximum per ear and no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no deductibles and no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for eyewear. The plan provides a $50 annual maximum for routine eye exams (limited to one per year) and a $150 annual maximum allowance for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered under Aetna Medicare Premier (PPO), which features a combined in- and out-of-network maximum annual benefit of $1,000. Medicare-covered dental services require a $40 copay and no coinsurance, while covered preventive and comprehensive services have no copay and no coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, subject to prior authorization. These covered benefits feature no copays, with coinsurance ranging from no coinsurance to 20% depending on the service.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Premier (PPO) plan, with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $50 copay for diagnostic procedures, while radiological services include a $5 copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic radiological services.
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
Aetna Medicare Premier (PPO) covers cardiac rehabilitation services with no coinsurance. Members will pay a $20 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $25 copay for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Premier (PPO), offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and up to $90 every three months in reimbursed over-the-counter items. Acupuncture, meal benefits, and Dual Eligible SNP services are not covered.
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