A non-government entity
Aetna Medicare Gold (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Gold (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Gold (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Gold (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Gold (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 Gold (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 Gold (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $142.00. 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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 Gold (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Gold (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you pay your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order.
Additional Benefits
The Aetna Medicare Gold (PPO) plan offers a variety of benefits with varying costs. The plan covers inpatient hospital stays with a $450 copay, and outpatient services with copays ranging from $0 to $300. Emergency services have a $110 copay, and primary care visits are $5. The plan also includes coverage for preventive services with no copay, hearing exams with a $35 copay, and vision services with copays between $0 and $35. Dental services are covered with no copay, up to an annual maximum benefit. The plan also covers home health, skilled nursing, and other services, and has a $0 copay for many services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $450 copay for a Medicare-covered stay, and there is no copay for additional days. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Gold (PPO), including outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Gold (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Gold (PPO) plan. Ground Ambulance Services have a $250 copay, and Air Ambulance Services have a 20% coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Gold (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Aetna Medicare Gold (PPO) plan covers primary care services with a $5 copay, chiropractic services with a $15 copay (routine care not covered), and occupational therapy with a $15 copay. It also covers specialist visits with a $0-$35 copay, mental health specialty services with a $40 copay, and other health care professionals with a $0-$35 copay. Psychiatric services and opioid treatment program services have a $40 copay, and physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a 20% coinsurance and a $0-$45 copay.
Preventive Services See details
The Aetna Medicare Gold (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services such as health education, wigs for hair loss, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefit, and remote access technologies, with no copay. Kidney disease education services are covered with 20% coinsurance. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear, and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Gold (PPO) plan covers vision services including eye exams with a copay between $0 and $35, and eyewear with no copay. Eyewear has a combined maximum benefit of $150 per year.
Dental Services See details
The Aetna Medicare Gold (PPO) plan covers dental services, including 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 with no copay. Medicare dental services have a $35 copay, and there is a $1,000 annual maximum benefit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Gold (PPO) plan. 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 Gold (PPO) plan, but require prior authorization. The plan has a coinsurance of 20% for this service.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, though DME for use outside the home is not covered, and Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies. Diabetic Equipment includes Diabetic Supplies with a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Gold (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $5, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $250, and Outpatient X-Ray Services have a $15 copay. Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Gold (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 Gold (PPO) plan, but the specific services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Gold (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Gold (PPO) plan covers over-the-counter items and meal benefits with no copay. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved