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Aetna Medicare Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Freedom (PPO) in 2025, please refer to our full plan details page.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Freedom (PPO) is a PPO plan offered by CVS Health Corporation available for the 2025 plan year to people living in Southeast AL. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Freedom (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 Freedom (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 Freedom (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. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced 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 $590.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7900.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $14000.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Freedom (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance. Brand name and non-preferred drugs both have a 25% coinsurance.
Additional Benefits
The Aetna Medicare Freedom (PPO) plan offers coverage for a wide range of services, including inpatient and outpatient care, with varying copays and coinsurance depending on the service. The plan covers emergency services, primary care, preventive services, hearing, vision, and dental services, often with no copay. Additionally, the plan provides coverage for home health, skilled nursing, and other services like home infusion, dialysis, and medical equipment. This plan provides comprehensive coverage for many services, with additional benefits such as over-the-counter allowances, and prescription hearing aids. Some services, like ambulance, diagnostic radiology, and skilled nursing facilities, may require prior authorization. Copays and coinsurance rates vary depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a \$380 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, there is a \$355 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay of $0-$380, observation services with a $380 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual and group sessions with a $30 copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Freedom (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Freedom (PPO) plan. Ground Ambulance Services have a $295 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Freedom (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have copays of $110 for Worldwide Emergency and Urgent Coverage, and $295 for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Freedom (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay for routine care. The plan also covers occupational therapy services with a $30 copay, and physician specialist services with a copay between $0 and $30. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $30. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Freedom (PPO) plan covers preventive services including an annual physical exam with no copay. The plan also covers additional preventive services, with some services having a copay; these include Medicare-covered glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per ear annually, with a $0 copay for all types of prescription hearing aids except for inner ear, outer ear, and over-the-ear aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Freedom (PPO) plan covers vision services, including eye exams with a copay between $0 and $30, and routine eye exams with no copay. Eyewear is covered with no copay and a combined maximum benefit of $300 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Freedom (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatments, and other preventive services with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered with no copay, but maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a maximum plan benefit of $2,700 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Freedom (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Freedom (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance range. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. Radiological services require prior authorization.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Freedom (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Freedom (PPO) plan, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The copay for these services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Freedom (PPO) plan, but require prior authorization. There is no copay for days 1-25, and a $125 copay for days 26-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Freedom (PPO) plan's "Other Services" benefit covers over-the-counter items and meal benefits with no copay, but acupuncture is not covered. The plan provides a $90 allowance every three months for over-the-counter items, including nicotine replacement therapy and Naloxone.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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