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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.
Aetna Medicare Freedom (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Monroe and Surrounding Parishes. 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
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 Freedom (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying costs based on the drug tier and pharmacy type. For example, you'll have no copay for preferred generic drugs at preferred and mail order pharmacies, but a $12 copay at standard pharmacies. For standard generic drugs, you'll pay 21% coinsurance, and for preferred brand drugs, you'll pay 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Freedom (PPO) plan offers comprehensive coverage, including inpatient hospital stays with varying copays depending on the length of stay, and outpatient services with copays ranging from $0 to $225. The plan also covers a wide array of services, such as primary care with no copay, preventive services with no copay for many services, and dental and vision services with copays and maximum annual benefits. Additional benefits include ambulance services with copays, emergency services, home health services with no copay, and home infusion services. The plan provides coverage for hearing and vision services, and covers medical equipment with 20% coinsurance for durable medical equipment, as well as diagnostic and radiological services, and skilled nursing facility (SNF) services with varying copays.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $225 per day for days 1-8, and no copay for days 9-90 for Inpatient Hospital-Acute, and a copay of $458 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0 to $225, and observation services with a copay of $225. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay of $30 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Freedom (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
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; however, transportation services to health-related locations 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Transportation has a $295 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Freedom (PPO) plan covers primary care physician services with no copay, and specialist services with a copay between $0 and $30. Chiropractic services have a $20 copay, occupational therapy services have a $25 copay, and physical therapy and speech-language pathology services have a $25 copay. The plan also covers mental health, psychiatric, and opioid treatment services with a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $50.
Preventive Services See details
Preventive Services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Kidney Disease Education Services have a 20% coinsurance. Other preventive services may have a copay.
Hearing Services See details
Hearing exams have a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $500 per year, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered; OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Freedom (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay, with a combined maximum benefit of $400 per year for both in-network and out-of-network services. Routine eye exams have no copay and are covered once per year, while other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay and are unlimited.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other services like oral exams, dental x-rays, and more with no copay. The plan has a maximum benefit of $2,500 per year for both in and out-of-network services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Freedom (PPO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Freedom (PPO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Freedom (PPO) plan, with copays and coinsurance depending on the specific service. Diagnostic Procedures/Tests have a copay that ranges from $0 to $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Freedom (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Freedom (PPO) plan. Although the plan covers some services, the Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Freedom (PPO) with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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