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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 Eastern 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:
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Drug Coverage
The Aetna Medicare Signature (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge a copay starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications under this plan require coinsurance instead of flat copays during the initial coverage phase. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply to all pharmacy and mail-order types, with Tier 5 specialty prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust coverage for essential healthcare, featuring no copays or coinsurance for primary care visits and wellness exams. Specialist visits range from no copay up to $50, while emergency room visits carry a $130 copay and urgent care has a $50 copay. For inpatient hospital stays, there is no coinsurance, though members are responsible for a $382 daily copay for the first eight days of acute care. Supplemental services are also well-covered, with no copays or coinsurance for preventive dental care, routine hearing exams, and routine eye exams. Prescription hearing aids are covered up to $1,250 per ear annually with no copay, while eyeglasses and contacts have no copay up to a $100 annual limit. Additionally, members enjoy no copays for home health services and receive a $30 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $382 daily copay for days 1 to 8 and no copay thereafter, while psychiatric stays cost a $292 daily copay for days 1 to 8 and no copay for days 9 to 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $40 copay for outpatient substance abuse sessions. Outpatient hospital and observation services also have no coinsurance, with copays ranging from $0 to $382 depending on the service.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Signature (PPO) plan with a copayment of $140.00 or $145.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ambulance services with a $275 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are also covered up to a $250,000 maximum with no coinsurance, featuring a $130 copay for emergency or urgent services and a $275 copay for emergency transportation.
Primary Care See details
Primary care services under Aetna Medicare Signature (PPO) are covered with no copay and no coinsurance, while specialist visits require a $0 to $50 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay, mental health services require a $40 copay, and telehealth has a $0 to $50 copay with 20% coinsurance, all with no coinsurance unless specified. Chiropractic care is partially covered with a $15 copay and no coinsurance (routine and other chiropractic services are not covered), while podiatry services are not covered.
Preventive Services See details
Preventive Services under Aetna Medicare Signature (PPO) are partially covered, generally featuring no copay and no coinsurance for annual physicals, health education, and screenings, though kidney disease education requires a 20% coinsurance and no copay. Wigs for chemotherapy-related hair loss are covered up to $400 annually with no copay or coinsurance. Excluded services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered under the Aetna Medicare Signature (PPO) plan, with Medicare-covered exams requiring a $50 copay and no coinsurance. Routine hearing exams, fitting evaluations, and prescription hearing aids (up to $1,250 per ear annually) are covered with no copay and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no coinsurance and no deductibles, offering eye exams with a $0 to $50 copay and eyewear with no copay. Routine eye exams have no copay up to a $50 annual limit, while eyeglasses and contact lenses are covered with no copay up to a combined annual maximum of $100.
Dental Services See details
Aetna Medicare Signature (PPO) provides partially covered dental services, featuring no copay and no coinsurance for preventive care like exams and cleanings, and a $50 copay with no coinsurance for Medicare-covered dental. Comprehensive services such as restorative care and endodontics have no copay and 20% to 50% coinsurance up to a $1,000 annual limit, while fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment with no copays for durable medical equipment, prosthetics, medical supplies, and diabetic shoes. Coinsurance ranges from no coinsurance to 20% for most equipment and supplies, while prosthetic devices require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services, which require prior authorization. Diagnostic procedures and tests have a copay ranging from $0 to $200 with no coinsurance, while lab services feature no copay and no coinsurance. Therapeutic radiological services require a minimum 20% coinsurance, and outpatient X-rays have no copay.
Home Health Services See details
Home health services are covered by 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 by Aetna Medicare Signature (PPO) with no coinsurance, although some services are not covered, including standard cardiac rehabilitation (which carries a $20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and while a three-day inpatient hospital stay is not required prior to admission, additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering no copay and no coinsurance for over-the-counter items up to $30 every three months, annual wellness exams, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
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