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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 IN Southwest. 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 $10100.00 (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 $10100.00 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 coverage includes a $615 annual deductible. You can expect no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge a copay ranging from $2 to $6 for Tier 1, and $12 to $36 for Tier 2 medications. For brand-name and specialty medications, the plan utilizes coinsurance rather than set copays. Tier 3 (Preferred Brand) drugs have a 24% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) drugs require a 25% coinsurance across all pharmacy and mail-order options. Tier 5 specialty medications are only available in 1-month supplies.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust healthcare coverage with a $5 copay for primary care visits and specialist copays ranging from no copay to $40. Inpatient hospital stays require a $275 copay for days 1 through 6 and no copay for days 7 through 90, while outpatient hospital services feature a copay of up to $275 with no coinsurance. Emergency care is covered with a $130 copay, which is waived upon admission within 24 hours, and urgent care carries a $40 copay. For routine and preventive care, this plan provides annual physicals and routine eye and hearing exams with no copay. Dental benefits include preventive care with no copay and comprehensive services at 20% to 50% coinsurance up to a $1,000 annual limit, while hearing aids are covered up to $750 per ear. Home health services have no copay or coinsurance, and durable medical equipment is covered with no copay and up to 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $275 copay for days 1 through 6 and no copay for days 7 through 90. 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, featuring a $0 to $275 copay for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (PPO) with a copay of either $75.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $130 to $260, up to a maximum plan benefit of $250,000.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care visits for a $5 copay and specialist visits for a copay ranging from no copay to $40, both with no coinsurance. Physical, occupational, and speech therapies require a $30 copay and no coinsurance, while mental health services have a $40 copay with no coinsurance, and chiropractic and podiatry 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 physicals, health education, and glaucoma screenings, while kidney disease education has no copay and a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Signature (PPO), featuring no deductible and no coinsurance, with routine hearing exams and fitting evaluations having no copay while Medicare-covered exams require a $40 copay. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 annual maximum benefit per ear, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no coinsurance, offering routine eye exams with no copay and Medicare-covered exams with a copay of $0 to $40. Covered eyewear, including contacts and eyeglasses, features no copay and no coinsurance up to a combined maximum benefit of $175 annually.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), offering preventive care like cleanings and exams with no copay and no coinsurance, and comprehensive care with no copay and 20% to 50% coinsurance up to a $1,000 yearly limit. Medicare-covered dental services require a $40 copay and no coinsurance, while fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (PPO) with no copay, though prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Signature (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic shoes. Patients will pay no coinsurance to 20% coinsurance for DME, medical supplies, and diabetic supplies, while prosthetic devices require a 20% coinsurance, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic tests have a $0 to $75 copay with no coinsurance, lab services and diagnostic radiology have no copay, outpatient X-rays require a $10 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (PPO) with no coinsurance, though some services are not covered in practice. Specifically, Cardiac Rehabilitation ($20 copay), Intensive Cardiac Rehabilitation ($20 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for symptomatic PAD ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. While prior authorization is required and a prior three-day hospital stay is not needed, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the Aetna Medicare Signature (PPO) plan, with acupuncture and meal benefits not covered. Covered benefits, including annual wellness exams, screening mammographies, additional gFOBT and FIT tests, and up to $15 every three months for over-the-counter items, are provided with no copay and no coinsurance.
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