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Aetna Medicare Premier Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus (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 Plus (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus (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 2025.
It's important to know that Aetna Medicare Premier Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $70.00. 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 $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:
Sign up for Aetna Medicare Premier Plus (PPO)
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Drug Coverage
The Aetna Medicare Premier Plus (PPO) plan has an enhanced alternative drug benefit. The 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 you use. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance at both preferred and standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus (PPO) plan offers a wide array of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a $400 copay per stay, outpatient services with copays ranging from $0-$300, and emergency services with copays from $45-$110. Preventative services like annual physical exams and many others are covered with no copay, and vision and dental services are covered, including eye exams, eyewear, and dental services with copays ranging from $0-$30. Other key benefits include hearing exams with a $30 copay, and prescription hearing aids with a maximum benefit of $500 per year. Home health services, skilled nursing facility stays, and home infusion bundled services are covered with no copay. The plan also offers coverage for ambulance services, primary care, mental health services, and various diagnostic and radiological services with a range of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you have a $400 copay per stay, and for Additional Days, there is no copay. For Inpatient Hospital Psychiatric, there is a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for both are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay of $0-$300, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus (PPO) plan, with a $25 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Premier Plus (PPO). Ground ambulance services have a $235 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have copays of $110 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $235 for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Premier Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $30, and physical therapy and speech-language pathology services with a $30 copay. Mental health and psychiatric services are covered with a $30 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services including Health Education, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, and hearing aids (all types) are covered with no copay. Prescription hearing aids - Inner Ear, Outer Ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier Plus (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0-$30, and routine eye exams are covered with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, up to a combined maximum of $200 per year.
Dental Services See details
Dental Services are covered, including a $30 copay for Medicare Dental Services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1,750 per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier Plus (PPO) plan, but require prior authorization. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with a 0-20% coinsurance. Diabetic Equipment is covered, with coinsurance and copays for specific services, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $5, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have a copay of $80, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus (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 Plus (PPO) plan, but the plan does not cover any of the sub-services. The plan has a copay for Cardiac Rehabilitation Services, but specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Plus (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier Plus (PPO) plan covers Over-the-Counter (OTC) items with no copay and a maximum benefit coverage of $45 every three months. Acupuncture, 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 are not covered.
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