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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 North Carolina. 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 $7750.00 (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 $7750.00 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) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when filled through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options carry copays ranging from $2 to $6 for Tier 1, and $12 to $36 for Tier 2, depending on the supply length. Higher-tier medications require coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs incur a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail-order channels. Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care doctor visits, while specialist visits require a copay of $0 to $50. Inpatient hospital stays require a $382 daily copay for the first eight days of acute stays with no coinsurance, and emergency room visits carry a $130 copay that is waived if admitted. Outpatient surgery and diagnostic lab services are highly affordable, with many of these services requiring no copay. For additional wellness needs, this plan features no copay for routine dental cleanings, annual eye exams, and routine hearing tests. Coverage includes up to $1,250 per ear for prescription hearing aids with no copay, a $100 annual eyewear allowance, and comprehensive dental services up to a $1,000 yearly limit with 20% to 50% coinsurance. Members also benefit from a $30 quarterly allowance for over-the-counter health items at no cost.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $382 daily copay for days 1-8 of acute stays and a $292 daily copay for days 1-8 of psychiatric stays, with no copay for remaining covered days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Aetna Medicare Signature (PPO) feature no coinsurance across all categories, though prior authorization is required for most services. Patients will pay a copay of $0 to $382 for outpatient hospital services, $382 per stay for observation services, and $40 for outpatient substance abuse sessions, while ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Signature (PPO), featuring a $275 copay and no coinsurance for ground ambulance services, and a 20% coinsurance and no copay for air ambulance services. Prior authorization is required for ambulance services, and transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency coverage is available up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Primary care benefits under Aetna Medicare Signature (PPO) offer primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $50 copay and no coinsurance. Physical, occupational, and speech therapies cost a $35 copay with no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) offers partially covered preventive services, featuring no copay and no coinsurance for annual physicals, health education, and screenings, while kidney disease education requires no copay and a 20% coinsurance. However, sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, disease management, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing services with a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams, fitting evaluations, and prescription hearing aids up to $1,250 per ear. This benefit is partially covered, as OTC hearing aids along with inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature (PPO) with no deductible and no coinsurance, featuring no copay for annual routine eye exams and up to a $50 copay for Medicare-covered exams. Covered eyewear, including contact lenses and eyeglasses, also features no copay up to a combined annual maximum benefit of $100.
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 Medicare-covered dental with a $50 copay and no coinsurance. Comprehensive dental services are covered up to a $1,000 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic services, and other preventive 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. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays and coinsurance ranging from 0% to 20%, except for prosthetic devices which require a flat 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Signature (PPO) plan, featuring no coinsurance and a $0 to $200 copay for diagnostic procedures, alongside lab services and outpatient X-rays with no copay. Diagnostic radiological services require a minimum $0 copay, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorization required for these services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (PPO) offers Cardiac Rehabilitation Services with no coinsurance; however, while some services are covered, standard cardiac ($20 copay), intensive cardiac ($20 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not necessary, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services with no copay and no coinsurance, which includes an annual wellness exam, screening mammography, additional gFOBT and FIT, and over-the-counter (OTC) items with a $30 maximum benefit every three months. Acupuncture and meal benefits are not covered.
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