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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 Central Ohio Area. 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 $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 Signature (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail-order services, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For higher-tier medications, this plan transitions to coinsurance costs. Tier 3 preferred brand-name drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order options, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive coverage with predictable costs, featuring no copayments for routine home health care, annual physicals, and preventive exams. For primary care visits, you will pay a low $5 copay, while specialist visits range from no copay to a $45 copay. Inpatient hospital stays require a $385 daily copay for the first several days, after which there is no copay, and outpatient hospital services range from no copay up to a $385 copay. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copays, along with allowances for prescription hearing aids and eyewear. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgent care visits require a $50 copay. Most diagnostic services, home infusion, and medical equipment feature no copays, though some specialized treatments and dialysis may require up to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, but prior authorization is required. For acute care, there is a $385 daily copay for days 1-7 and no copay for days 8 and beyond, whereas psychiatric care requires a $385 daily copay for days 1-6 and no copay for days 7-90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Signature (PPO) are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Patients will pay a $0 to $385 copay for outpatient hospital services, a $385 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of either $40.00 or $145.00 and no coinsurance. Prior authorization is required for these covered benefits.
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, both requiring prior authorization. These ambulance fees are not waived if you are admitted to the hospital, and transportation services are not covered under this plan.
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 urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance and a $250,000 maximum benefit, requiring a $130 copay for emergency or urgent care and a $275 copay for emergency transportation.
Primary Care See details
Primary Care benefits under the Aetna Medicare Signature (PPO) include primary care physician visits for a $5 copay and specialist visits for no copay to a $45 copay, both with no coinsurance. Physical, occupational, mental health, and psychiatric therapies require a $40 copay with no coinsurance, podiatry costs a $45 copay with no coinsurance, telehealth ranges from no copay to a $50 copay with 20% coinsurance, and chiropractic 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 physical exams, health education, fitness programs, and glaucoma screenings, while kidney disease education has no copay and a 20% coinsurance. Several supplemental benefits are not covered under this plan, including weight management, personal emergency response systems, alternative therapies, and in-home safety assessments.
Hearing Services See details
Aetna Medicare Signature (PPO) provides partially covered hearing services, with Medicare-covered exams requiring a $45 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. While some prescription hearing aid services are covered up to a $1,250 annual maximum per ear with no copay or coinsurance, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription aids, are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature (PPO) with no coinsurance, no deductibles, and no copay for routine eye exams or eyewear. Routine exams are limited to one per year with a $50 annual maximum, eyewear has a combined yearly limit of $150, and Medicare-covered exams carry a copay of up to $45.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), with Medicare-covered dental requiring a $45 copay and no coinsurance, and exams, cleanings, and x-rays available with no copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $1,000 annual maximum, though other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for covered items. Coinsurance ranges from no coinsurance up to 20% depending on the equipment, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Aetna Medicare Signature (PPO) plan, with diagnostic lab services requiring no copay and diagnostic procedures ranging from no copay up to a $95 copay, both featuring no coinsurance. Radiological services require prior authorization and include diagnostic radiological services with no copay, outpatient X-rays with a $5 copay, and therapeutic radiological services with 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior three-day hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Signature (PPO), which offers an annual wellness exam, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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