A non-government entity
Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Upstate NY 1. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $13900.00 (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 $13900.00 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 Signature (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using preferred retail pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options charge a small copay for these lower-tier drugs, ranging from $2 to $12 for a one-month supply. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance rate. Specialty medications under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage featuring no coinsurance for many core services, including inpatient hospital stays, outpatient procedures, and doctor visits. Primary care visits require a low $10 copay, while routine preventive services, annual physicals, and laboratory tests are available with no copay. For urgent and emergency needs, members pay a $40 copay for urgent care and a $115 copay for emergency room visits, which also includes worldwide emergency protection. Routine dental, vision, and hearing exams are fully covered with no copay, and members also benefit from no copay on routine eyewear up to a $100 annual limit. Skilled nursing facility stays and home health services are accessible with no copay for initial periods, though some specialized services like dialysis, medical equipment, and Part B drugs require up to a 20% coinsurance. Overall, this plan minimizes out-of-pocket expenses by replacing coinsurance with predictable copays or entirely free coverage for most routine and preventive care.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $407 daily copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and a $346 daily copay for days 1 to 6 of psychiatric stays (no copay for days 7 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $407 for outpatient hospital and observation services, and a $45 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under the Aetna Medicare Signature (PPO) plan, where Medicare-covered ground and air ambulance services require a $300 copay and no coinsurance. Prior authorization is required for ambulance services, and transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Signature (PPO) with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care is covered with a $40 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 maximum with no coinsurance, carrying a $115 copay for emergency or urgent care and a $300 copay for emergency transportation.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care visits for a $10 copay and specialist visits for a range of no copay to a $50 copay, both with no coinsurance. While chiropractic and podiatry services are not covered, the plan covers physical, occupational, and mental health therapies with copays ranging from $35 to $45 and no coinsurance. Telehealth benefits are also available with 20% coinsurance and copays ranging from no copay to $50.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance for annual physicals and screenings, though kidney disease education has a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, and home-based palliative care.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing services, including Medicare-covered exams for a $50 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with copays up to $1,700 and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles and no coinsurance, offering routine annual eye exams and eyewear with no copay. Eyewear has a combined maximum benefit of $100 per year, while other covered eye exams may require a copay of up to $50.
Dental Services See details
Aetna Medicare Signature (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $50 copay and no coinsurance, as well as routine cleanings, exams, and X-rays with no copay and no coinsurance. However, several sub-services are not covered, including fluoride treatments, orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance up to 20% for durable medical equipment, medical supplies, and diabetic supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services with no coinsurance and a $0 to $50 copay for diagnostic tests, and no copay for lab services. Diagnostic radiological services start at no copay, outpatient X-rays have a $50 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Signature (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 Signature (PPO) plan with no coinsurance, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a 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
Aetna Medicare Signature (PPO) partially covers other services, offering a meal benefit for chronic illnesses, an annual wellness exam, and additional screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered.
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