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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 Lexington 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 $9550.00 (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 $9550.00 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 has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using preferred pharmacies or preferred mail order services. If you choose standard pharmacies or standard mail order services, copays start at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications under this plan transition to a percentage-based coinsurance. Tier 3 preferred brand 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 Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust medical coverage with predictable copays and no coinsurance for many core services. Under this plan, primary care visits require a low $5 copay, while specialist visits range from no copay to a $40 copay. Inpatient hospital stays feature no coinsurance and a $310 daily copay for the first six days, and emergency care is covered with a $130 copay. In addition to medical care, the plan provides valuable routine vision, dental, and hearing benefits with no copay for preventive exams. Prescription hearing aids are covered up to $1,000 per ear annually, while comprehensive dental services require 20% to 50% coinsurance up to a $1,000 annual limit. Members also receive a $45 quarterly over-the-counter allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital care with no coinsurance, requiring a $310 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $310, observation services require a $310 copay per stay, and outpatient substance abuse sessions have a $40 copay.
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 services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Routine transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay (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 care are also covered with no coinsurance and a $130 copay ($250 copay for worldwide emergency transportation), up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care visits with a $5 copay and specialist visits with no copay to a $40 copay, both with no coinsurance. Other services like physical therapy, occupational therapy, and mental health sessions require a $40 copay and no coinsurance, while telehealth features no copay to a $50 copay with 20% coinsurance. Chiropractic services are partially covered, as routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, health education, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Supplemental services such as weight management, personal emergency response systems, therapeutic massage, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Signature (PPO), offering Medicare-covered exams for a $40 copay, and annual routine exams and fitting evaluations with no deductible, copay, or coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with a $0 to $40 copay and eyewear with no copay. Eye exams are subject to a $50 annual maximum, while contact lenses, eyeglasses, and upgrades are covered up to a $150 combined annual limit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), with medicare-covered dental requiring a $40 copay and no coinsurance, and preventive services available with no copay and no coinsurance. Comprehensive dental care is covered with no copay and 20% to 50% coinsurance up to a $1,000 annual limit, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the Aetna Medicare Signature (PPO) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs feature a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require 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 for these services.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Signature (PPO) with no copays, while coinsurance ranges from no coinsurance up to 20% depending on the item. This benefit includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment, which generally require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO), requiring prior authorization for all services. Diagnostic services feature no coinsurance, a $0 to $50 copay for procedures, and no copay for lab tests, while radiological services include a $0 minimum copay for diagnostic radiology, no copay for outpatient X-rays (coinsurance applies), and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Signature (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (PPO) covers cardiac rehabilitation services with no coinsurance. Members pay a copay of $20 for standard and intensive cardiac rehabilitation, $15 for pulmonary rehabilitation, and $25 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) provides partially covered Other Services with no copay and no coinsurance, though acupuncture, meal benefits, and dual-eligible SNP services are not covered. Covered benefits under this category include annual wellness exams, select colorectal screenings, and an over-the-counter (OTC) benefit with a maximum allowance of $45 every three months.
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