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Aetna Medicare Premier Plus 1 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus 1 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier Plus 1 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus 1 (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Denver Metro & Northern Colorado. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Plus 1 (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 Premier Plus 1 (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 Premier Plus 1 (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 $590.00 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 $8950.00 (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 $8950.00 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 Premier Plus 1 (PPO)
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Drug Coverage
The Aetna Medicare Premier Plus 1 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the tier and pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, with a $12 copay at standard pharmacies and standard mail order. For all other tiers, you will pay coinsurance of 24% or 25% depending on the drug. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus 1 (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. Many services, like primary care visits, preventive services, and vision exams, have no copay, while others like emergency services, dental services, and specialist visits have copays. The plan also covers hearing aids, home health services, and medical equipment, with some services requiring coinsurance or prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Premier Plus 1 (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $295 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, there is a $370 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, along with Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $350, while Observation Services have a $350 copay. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Aetna Medicare Premier Plus 1 (PPO) covers partial hospitalization with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $200 copay, while air ambulance services have 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier Plus 1 (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $200 copay.
Primary Care See details
Primary Care services with Aetna Medicare Premier Plus 1 (PPO) include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and a $15 copay for Occupational Therapy Services. Physician Specialist Services and Other Health Care Professional services have a copay between $0 and $45, while Mental Health and Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $15 copay, and Additional Telehealth Benefits have a 20% coinsurance with a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Premier Plus 1 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered annually with no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per year, and prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services with the Aetna Medicare Premier Plus 1 (PPO) plan include eye exams and eyewear. Eye exams have no copay, and eyewear has no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $45 copay, and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Aetna Medicare Premier Plus 1 (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier Plus 1 (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies and Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier Plus 1 (PPO) plan covers diagnostic and radiological services, including Diagnostic Procedures/Tests with a copay between $0 and $20, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $100, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus 1 (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 Premier Plus 1 (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Plus 1 (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier Plus 1 (PPO) plan does not cover acupuncture, 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. Over-the-Counter (OTC) Items and Meal Benefits are covered with no copay. Other services such as annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay.
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