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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 North Carolina. 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 $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 $6900.00 (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 $6900.00 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 a $500 drug deductible. You can secure significant savings on generic medications by utilizing preferred pharmacies or preferred mail-order services, which offer no copay for both Tier 1 Preferred Generic and Tier 2 Generic drugs. If you choose standard pharmacies or standard mail-order options, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For brand-name and specialty medications, cost-sharing is structured as coinsurance across all pharmacy networks. 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 Tier drugs require a 27% coinsurance for a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage with no copays for primary care doctor visits and low copays ranging from $0 to $35 for specialists. Patients facing hospital stays will pay daily copays for the first eight days of inpatient care, followed by no copay for subsequent days, while outpatient hospital services require a copay of up to $382. Emergency care is accessible with a $130 copay that is waived upon admission, and urgent care visits require a $50 copay. For extra wellness support, the plan features no copays or coinsurance for routine dental, vision, and hearing exams. Members receive up to $1,250 per ear annually for prescription hearing aids, a $150 annual allowance for eyewear, and a $30 quarterly allowance for over-the-counter items. Home health services are also fully covered with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) inpatient hospital benefits are partially covered with no coinsurance, though prior authorization is required. For acute stays, you pay a $382 daily copay for days 1 to 8 and no copay for days 9 and beyond, whereas psychiatric stays require a $292 daily copay for days 1 to 8 and no copay for days 9 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Aetna Medicare Signature (PPO) are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient substance abuse sessions require a $40 copay, while outpatient hospital and observation services have a copay of up to $382 per stay and may require prior authorization.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of $140 or $145 and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays of $130 for emergency or urgent care and $275 for emergency transportation.
Primary Care See details
Aetna Medicare Signature (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Signature (PPO), featuring no copay and no coinsurance for annual physicals, fitness benefits, health education, and glaucoma screenings, while kidney disease education requires no copay and a 20% coinsurance. Non-covered 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 or dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (PPO) provides partially covered hearing services, including Medicare-covered exams for a $35 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with a $0 to $35 copay and eyewear with no copay. Routine eye exams and follow-up diabetic exams have no copay, while eyewear including glasses and contacts is covered up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and x-rays. Comprehensive services require no copay and a 20% to 50% coinsurance up to a $1,500 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs have a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry no coinsurance and a copay ranging from $0 to $200, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Signature (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Signature (PPO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not necessary, and additional days beyond the 100-day limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, including annual wellness exams, screening mammography, additional gFOBT and FIT, and up to $30 every three months for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
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