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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 Pennsylvania. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays for Tier 1 drugs start at $2, while Tier 2 generics start at a $12 copay for a one-month supply. For higher-tier medications, costs shift to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust coverage with no copay for primary care visits and no coinsurance across many standard medical services. For acute inpatient hospital stays, you will pay a $175 daily copay for the first five days and no copay for subsequent days. Emergency room visits require a $130 copay, which is waived if you are admitted, while urgent care services carry a $50 copay. Specialist visits range from no copay to a $30 copay, while home health services and laboratory tests are covered with no copay. Routine vision and hearing exams also require no copay, and the plan includes a $175 eyewear allowance and up to $500 per ear annually for prescription hearing aids. Preventive dental care features no copay, while comprehensive dental services require 20% to 50% coinsurance up to a $1,500 annual limit.
Inpatient Hospital See details
Inpatient Hospital benefits under the Aetna Medicare Signature (PPO) are partially covered with no coinsurance, though prior authorization is required. For acute stays, you pay a $175 daily copay for days 1-5 and no copay for day 6 and beyond, whereas psychiatric stays require a $350 daily copay for days 1-5 and no copay for days 6-90. 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 copays for ambulatory surgical center and blood services. Patients will pay a $0 to $175 copay for outpatient hospital services, a $175 copay per stay for observation services, and a $30 copay for outpatient substance abuse sessions, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by the Aetna Medicare Signature (PPO) plan with no coinsurance, though prior authorization is required. Depending on the service, you will pay either no copay or a $145 copay.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Signature (PPO) with a $130 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care requires a $50 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 limit with no coinsurance, requiring a $130 copay for emergency or urgent care and a $225 copay for emergency transportation.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $30 copay and no coinsurance. Therapy, mental health, podiatry, and psychiatric services require copays ranging from $20 to $30 with no coinsurance, while some chiropractic services are covered with a $10 copay and no coinsurance, though routine and other chiropractic services are not covered. Telehealth services are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Signature (PPO) preventive services are partially covered, offering an annual physical exam, health education, and select screenings with no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Excluded from coverage are in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge 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, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (PPO) hearing services are partially covered, featuring a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductible and no coinsurance, featuring a $0 to $30 copay for eye exams and no copay for eyewear. This plan provides up to a $50 annual maximum for eye exams, which includes one routine exam per year, and a combined $175 annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), excluding fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services. Covered preventive services have no copay and no coinsurance, Medicare-covered dental requires a $30 copay and no coinsurance, and covered comprehensive services have no copay and 20% to 50% coinsurance up to a $1,500 annual limit.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (PPO) with no copay, although prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Signature (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays, though prior authorization is required. Durable medical equipment, medical supplies, and diabetic supplies have a coinsurance ranging from no coinsurance to 20% (20% for prosthetic devices), while diabetic therapeutic shoes and inserts feature no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO) with no copay or coinsurance for lab services, diagnostic tests, and diagnostic radiological services. Outpatient X-rays require a $10 copay, therapeutic radiological services carry a 20% coinsurance, and prior authorization is required for these services.
Home Health Services See details
Home Health Services are covered under Aetna Medicare Signature (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Signature (PPO) covers some services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $210 daily copay for days 21 through 100. Prior authorization is required, though a three-day prior inpatient hospital stay is not, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services with no copay and no coinsurance, including chronic illness meals, wellness exams, mammography screenings, and a $30 quarterly over-the-counter allowance. Acupuncture is not covered under this benefit.
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