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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 Central Massachusetts. 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 $500.00 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 $500. Under the initial coverage phase, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail order service. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6 and Tier 2 copays range from $12 to $36, depending on the fill supply. Higher-tier medications are subject to coinsurance rather than set copays across all pharmacy types. You can expect a 22% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Specialty medications in Tier 5 carry a 27% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, including a low $5 copay for primary care visits and copays ranging from no copay up to $50 for specialist visits. For inpatient hospital stays, members pay a daily copay for the first six days and no copay for subsequent days, while emergency room visits carry a $130 copay with no coinsurance. Outpatient hospital services and diagnostic lab tests are also highly accessible, featuring no coinsurance and often requiring no copay. Routine preventive care, annual physicals, and routine dental, vision, and hearing exams are fully covered with no copay and no coinsurance. The plan also provides home health services with no copay, prescription hearing aid coverage, and a $100 annual allowance for routine eyewear with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Signature (PPO) with no coinsurance, though prior authorization is required. Acute stays require a $458 copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric stays require a $390 copay for days 1 through 6 and no copay for days 7 through 90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $375 and observation services with a $395 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $50 copay per session with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the specific service, you will pay a copayment of either $70.00 or $145.00.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Signature (PPO) with a $285 copay for ground transport and a 20% coinsurance for air transport, both requiring prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $130 to $285, up to a maximum plan benefit of $250,000.
Primary Care See details
Primary care benefits under Aetna Medicare Signature (PPO) include primary care visits for a $5 copay and specialist visits for a copay ranging from no copay to $50, both with no coinsurance. Most therapy, mental health, and psychiatric services require a $50 copay with no coinsurance, while telehealth services carry a 20% coinsurance and a copay ranging from no copay to $50, and podiatry and routine chiropractic care are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) offers preventive services, including annual physical exams, health education, and glaucoma screenings, with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, but additional preventive benefits are only partially covered, excluding services such as weight management, personal emergency response systems, and nutritional benefits.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Signature (PPO), featuring annual routine exams and fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $50 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and copays ranging from no copay up to $1,700, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature (PPO) with no coinsurance or deductibles, offering routine eye exams and eyewear with no copay. Other covered eye exams require a copay of up to $50, and eyewear coverage is limited to a combined maximum of $100 per year.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Signature (PPO) plan, with Medicare-covered dental services requiring a $50 copay and no coinsurance, while covered preventive exams, cleanings, and x-rays have no copay and no coinsurance. Non-covered sub-services include fluoride, other diagnostic or preventive dental, restorative, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay, no coinsurance, and no deductible, while chemotherapy and other Part B drugs require no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers durable medical equipment (DME) and medical supplies with no copay and coinsurance ranging from no coinsurance to 25%. Prosthetic devices are covered with no copay and 25% coinsurance, while diabetic supplies and services are covered with no copay for therapeutic shoes and inserts and up to 20% coinsurance for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO), featuring no copay and no coinsurance for lab services, and diagnostic tests ranging from no copay up to a $40 copay with no coinsurance. Outpatient X-rays require a $10 copay and coinsurance, diagnostic radiology copays start at $0 with no coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Signature (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 offered by Aetna Medicare Signature (PPO) with no coinsurance. While some services are covered, standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copayment of $10 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering a chronic illness meal benefit, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual eligible SNPs with highly integrated services are not covered.
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