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Aetna Medicare Explorer Premier 2 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer Premier 2 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Explorer Premier 2 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer Premier 2 (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in SNJ Counties: ATL, BUR, CAM, CPM, CUM, GLO, SLM. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Explorer Premier 2 (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 Explorer Premier 2 (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 Explorer Premier 2 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $75.00. 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 $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $450.00 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 $14000.00 (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 $14000.00 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 Explorer Premier 2 (PPO) plan has a $450 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 22% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan also offers a reduced premium if you qualify for the low-income subsidy, with the premium dropping from $70.40 to $13.50. Be sure to check the plan's formulary for specific drug coverage details.
Additional Benefits
The Aetna Medicare Explorer Premier 2 (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, while outpatient services can have copays from $0 to $300. Emergency services, primary care visits, preventive services, and many vision and dental services have no copay. This plan also covers ambulance services with a copay, and offers benefits for hearing aids and eyewear. Home health services and skilled nursing facilities are covered with no copay for some days, and the plan includes coverage for home infusion services and dialysis services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $335 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $339 for days 1-6, and no copay for days 7-90 for Inpatient Hospital Psychiatric; additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $300, observation services with a $335 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Explorer Premier 2 (PPO) plan, with a $60 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer Premier 2 (PPO) plan, with no coinsurance. Ground and air ambulance services have a $300 copay, 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 under the Aetna Medicare Explorer Premier 2 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services have a $45 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Explorer Premier 2 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and physician specialist services with a copay between $0 and $35. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Explorer Premier 2 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as Health Education, Nutritional/Dietary Benefit, and Wigs for Hair Loss Related to Chemotherapy, are covered with no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, and Telemonitoring Services, are not covered. 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 for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered, with a maximum copay of $1700 for two hearing aids per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
The Aetna Medicare Explorer Premier 2 (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and routine eye exams with no copay. Eyewear is covered with no copay and a combined maximum of $250 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Explorer Premier 2 (PPO) plan covers Medicare dental services with a $35 copay, and other dental services including oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Explorer Premier 2 (PPO) plan and require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Explorer Premier 2 (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%, while Medical Supplies and Diabetic Supplies have a coinsurance of 0% to 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay between $0 and $35, lab services with no copay, diagnostic radiological services with a copay up to $275, therapeutic radiological services with up to 20% coinsurance, and outpatient X-ray services with a $35 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Explorer Premier 2 (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 technically covered, but not in practice, as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services, but the specific cost sharing details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $175.
Other Services See details
The Aetna Medicare Explorer Premier 2 (PPO) plan does not cover acupuncture, over-the-counter items, 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, or Self-Directed Personal Assistance Services. The plan covers a meal benefit with no copay, and other services including annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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