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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 Northwest. 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) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling your prescriptions at preferred pharmacies or through preferred mail-order services. If you choose standard pharmacies or standard mail-order services, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For brand-name and specialty medications, this plan utilizes coinsurance rather than set copays. Tier 3 preferred brand drugs have a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy network options. Note that Tier 5 specialty medications are only available for a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay for home health services, preventive physicals, and annual wellness exams. For routine medical care, you will pay a low $5 copay for primary care visits and a $40 copay for specialists, with no coinsurance required. Inpatient hospital stays require a copay of $350 per day for the first seven days of acute care, while emergency room visits carry a $130 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and hearing aids. Outpatient diagnostic lab tests and home infusion services are also covered with no copay, while durable medical equipment and dialysis require up to 20% coinsurance. Please note that certain services, such as routine podiatry, over-the-counter items, and acupuncture, are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital care is covered under Aetna Medicare Signature (PPO) with no coinsurance, requiring a $350 copay for days 1 to 7 of acute stays and a $325 copay for days 1 to 7 of psychiatric stays, followed by no copay for days 8 to 90. While unlimited additional acute days are covered at no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) outpatient services are covered with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $350, observation services carry a $350 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (PPO) with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Signature (PPO) with a $285 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport, both requiring prior authorization. These costs are not waived if you are admitted to the hospital, and transportation services are not covered.
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 $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $250,000 limit, carrying copays of $130 for emergency or urgent care and $285 for transportation.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care visits for a $5 copay, specialist visits for a $40 copay, and therapy services for a $30 copay, all with no coinsurance. Podiatry is not covered, telehealth is offered with no copay to a $40 copay and 20% coinsurance, and chiropractic care covers some services for a $15 copay and no coinsurance, though routine 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 physicals, fitness benefits, and screenings, while kidney disease education requires a 20% coinsurance and no copay. Supplemental sub-services including In-Home Safety Assessments, PERS, Medical Nutrition Therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Aetna Medicare Signature (PPO) covers Medicare-covered hearing exams for a $40 copay and no coinsurance, while routine hearing exams and fitting evaluations are covered annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear annually, 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 deductible and no coinsurance, offering routine eye exams and eyewear with no copay. Medicare-covered eye exams carry a copay of up to $40, and the plan provides up to $50 annually for routine exams and a $125 annual limit for eyewear.
Dental Services See details
Aetna Medicare Signature (PPO) dental services are partially covered, offering preventive care like oral exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $40 copay and no coinsurance. Other covered services like restorative care and endodontics carry no copay and 20% to 50% coinsurance up to a $1,000 annual limit, while fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Aetna Medicare Signature (PPO) plan with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers durable medical equipment, prosthetics, and diabetic supplies with no copays 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
Aetna Medicare Signature (PPO) covers diagnostic and radiological services, with diagnostic services requiring no coinsurance, no copay for lab services, and a $0 to $75 copay for diagnostic procedures. Covered radiological services feature outpatient X-rays for a $20 copay, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Signature (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, but specific services including 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
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring a daily copayment of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required and a prior three-day inpatient hospital stay is not necessary, but additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. However, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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