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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 Western New York. 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 $13900.00 (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 $13900.00 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 Signature (PPO)
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Drug Coverage
The Aetna Medicare Signature (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail-order services, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply fill. For higher-tier medications, costs are based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for many core services. Under this plan, primary care visits require a low $5 copay, while specialist visits and emergency care range from no copay to a $40 and $115 copay, respectively. Inpatient hospital stays require a $300 daily copay for the first six days, followed by no copay for additional days. For routine wellness, beneficiaries enjoy no copay and no coinsurance for home health visits, annual routine hearing exams, and preventive dental services like cleanings and x-rays. Vision care and prescription hearing aids are also covered with no coinsurance, though copays apply to hearing aids and certain diagnostic services. Medical equipment and outpatient dialysis require no copay but are subject to a coinsurance of up to 20 percent.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring prior authorization. Acute stays require a $300 daily copay for days 1-6 and no copay for additional days, while psychiatric stays require a $346 daily copay for days 1-6 and no copay for days 7-90; upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $300 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copays or coinsurance, while individual and group outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (PPO) with a copay of $80.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgent care with a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $115 to $300, up to a $250,000 maximum benefit limit.
Primary Care See details
Primary care benefits under the Aetna Medicare Signature (PPO) plan offer primary care physician visits for a $5.00 copay and no coinsurance, and specialist visits with no copay to a $40.00 copay and no coinsurance. Other services like physical, occupational, and mental health therapies have copays ranging from $25.00 to $40.00 and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) provides partially covered preventive services, with most covered benefits—like annual physical exams, health education, and glaucoma screenings—costing no copay and no coinsurance, though kidney disease education requires a 20% coinsurance and no copay. Several supplemental services are excluded from coverage, including in-home safety assessments, weight management programs, and medical nutrition therapy.
Hearing Services See details
Aetna Medicare Signature (PPO) offers partially covered hearing services, including Medicare-covered exams for a $40 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $0 to $1,700, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services covered by the Aetna Medicare Signature (PPO) require no deductibles or coinsurance, offering eye exams for a $0 to $40 copay and eyewear with no copay. Beneficiaries receive up to $50 annually for eye exams, including one routine exam with no copay, and a $100 annual combined maximum allowance for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by the Aetna Medicare Signature (PPO) plan, with Medicare-covered dental services requiring a $40 copay and no coinsurance. Covered preventive services such as oral exams, cleanings, and dental x-rays have no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, prosthodontic, implant, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require 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. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO) with prior authorization, featuring no copay or coinsurance for lab services. Outpatient diagnostic tests range from no copay to a $40 copay, diagnostic radiology starts with no copay, outpatient X-rays cost a $35 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the 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 with no coinsurance under the Aetna Medicare Signature (PPO) plan, but only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are partially covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring prior authorization but no prior 3-day hospital stay. There is no copay for days 1 through 20 and a $214 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering a chronic illness meal benefit, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNPs are not covered under this plan's other services benefit.
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