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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 2025, 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 Metro Area: NYC, Queens, Brooklyn, SI, Nassau. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $81.00. 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 $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) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will have no copay at preferred pharmacies and no copay when using preferred mail order. Standard generic drugs have 24% coinsurance, while preferred and non-preferred brand drugs have 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers a variety of benefits with varying costs. You'll pay a copay for inpatient hospital stays, outpatient services, and emergency services. Many services have no copay, including preventive care like an annual physical exam, routine vision and hearing exams, and dental cleanings. The plan also covers ambulance services, with a copay for both ground and air transport. Additionally, services like home health, skilled nursing facilities, and medical equipment have varying costs, with some services having no copay or coinsurance. However, some services, like podiatry, orthodontic, and certain vision and dental procedures, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by Aetna Medicare Premier (PPO). For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $395, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan. The plan has an $80 copay for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare Premier (PPO) plan covers ambulance services with a $280 copay for both ground and air ambulance services, and no coinsurance. 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 Premier (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $55 copay, with no coinsurance for either. Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $280 copay for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, and specialist services with a copay between $0 and $40. Mental health and psychiatric services, as well as opioid treatment, have a $40 copay for individual or group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services have a copay, including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, but other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$40, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum plan benefit of $200 per year.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers oral exams and dental X-rays with no copay, and prophylaxis (cleaning) with no copay. However, fluoride treatments, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, the copay is $35.00. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance; and Medical Supplies and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Outpatient X-ray services have a $40 copay, while diagnostic radiological services have a copay of up to $300 and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier (PPO) plan, but the specific services are not covered. The plan has a copay for certain Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan, with a $0 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF are not covered.
Other Services See details
The Aetna Medicare Premier (PPO) plan does not cover acupuncture, over-the-counter items, 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. The plan covers a meal benefit with no copay, and annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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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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