A non-government entity
Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in West FL. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (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 (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 (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 $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:
Sign up for Aetna Medicare Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Premier (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible is met, you will pay the following costs for your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services and primary care physician visits may have no copay. The plan also covers preventive, hearing, vision, and dental services, with copays and coinsurance depending on the specific service. Additional benefits include ambulance and emergency services, with copays for ground and air ambulance. Home health and skilled nursing facility services have copays for some days of coverage. Other services, such as home infusion, medical equipment, and diagnostic services, are also covered, with specific copays, coinsurance, and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits for Aetna Medicare Premier (PPO) include a $290 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $290, observation services with a $290 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $30 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, but requires prior authorization, and has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, and air ambulance services have 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Transportation has a $275 copay; all other services have no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $35 copay and no coinsurance. Physician Specialist Services have a copay between $0 and $45. Mental Health Specialty Services, including individual and group sessions, have a $30 copay. Other Health Care Professional services have a copay between $0 and $45. Psychiatric Services, including individual and group sessions, have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $35 copay and no coinsurance. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids are covered, with a maximum copay of $1700 for Prescription Hearing Aids (all types). Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are also not covered.
Vision Services See details
The Aetna Medicare Premier (PPO) plan covers vision services, including eye exams with a copay of $0-$45, and eyewear with no copay. Eyewear benefits include a combined maximum of $120 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers dental services, with a $45 copay for Medicare dental services. 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 have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $2,300 maximum plan benefit coverage amount per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Premier (PPO), including Durable Medical Equipment (DME) with 0% to 20% coinsurance, Prosthetics/Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment with 0% to 20% coinsurance. Durable Medical Equipment for use outside the home is not covered, and prior authorization is required for some services.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier (PPO) plan covers Diagnostic and Radiological Services, including Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $250, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. The copay for these services is described in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier (PPO), with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Premier (PPO) plan covers Over-the-Counter (OTC) items with no copay, and Other 1 and Other 2 services with no copay. Acupuncture, Meal Benefit, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved