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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 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 Kent, New Castle, Sussex counties. 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 $87.00. 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 $11300.00 (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 $11300.00 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 an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply duration. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. These coinsurance rates apply equally across all preferred and standard pharmacy or mail-order options, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialist visits, patients can expect a copay of up to $30, while inpatient hospital stays require a $400 copay per stay with no coinsurance. Emergency care is accessible with a $115 copay, which is waived if you are admitted within 24 hours, and urgently needed services carry a $40 copay. This plan also includes valuable supplemental benefits, featuring preventive and comprehensive dental care with no copay up to a $1,500 annual limit. Routine hearing exams are available with no copay, while vision exams range from no copay up to $30, alongside allowances of $225 yearly for eyewear and $500 per ear annually for prescription hearing aids. Additionally, members receive a $30 quarterly allowance for over-the-counter items and pay no copay for durable medical equipment, though coinsurance up to 20% may apply.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient acute hospital stays with no coinsurance and a $400 copay per stay, excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric care is also covered with no coinsurance, featuring a $350 daily copay for days 1 through 5 and no copay for days 6 through 90, though additional psychiatric days 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 categories, including ambulatory surgical center and blood services which also feature no copay. Outpatient hospital services have a copay of $0 to $300, observation services require a $300 copay per stay, and outpatient substance abuse sessions carry a $30 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Premier (PPO) with no coinsurance, requiring a copay of either $55.00 or $110.00 depending on the service. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $295.
Primary Care See details
Aetna Medicare Premier (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, psychiatric, and opioid treatment services require up to a $30 copay and no coinsurance. Podiatry is not covered, some chiropractic services are covered but routine and other chiropractic services are not, and telehealth services carry a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Premier (PPO) preventive services are partially covered, offering annual physicals, screenings, and fitness benefits with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services that are not covered include weight management, alternative therapies, therapeutic massage, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, 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 covered by Aetna Medicare Premier (PPO), featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay and no coinsurance up to $500 per ear yearly, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams for a $0 to $30 copay and eyewear with no copay. Patients receive up to a $50 annual maximum for eye exams and a $225 yearly combined maximum for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Aetna Medicare Premier (PPO) offers partially covered dental services with a $1,500 annual maximum for both in-network and out-of-network care, though orthodontics, implant services, and maxillofacial prosthetics are not covered. Medicare-covered dental services require a $30 copay and no coinsurance, while other covered preventive and comprehensive services feature no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aetna Medicare Premier (PPO) plan with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other Part B drugs carry a coinsurance of 0% to 20%, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
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 durable medical equipment (DME), prosthetics, and diabetic supplies with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these covered benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (PPO) covers diagnostic and radiological services with no copay or coinsurance for lab services, diagnostic tests, and diagnostic radiology, though prior authorization is required. Outpatient X-rays require a $20 copay and coinsurance, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Premier (PPO) covers Home Health Services 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 Premier (PPO) plan, which provides no coverage, copayments, or coinsurance for intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Premier (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Premier (PPO) partially covers other services with no copay and no coinsurance, offering a chronic illness meal benefit, select wellness screenings, and a $30 quarterly over-the-counter allowance. Acupuncture is not covered under this plan.
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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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