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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 Central FL, North 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:
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Drug Coverage
The Aetna Medicare Premier (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After meeting your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at preferred pharmacies and through the mail. You will pay 24% coinsurance for standard generic drugs at any pharmacy. Once your total drug costs reach $2000.00, you will enter the next coverage phase.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay, but outpatient services can have copays between $0 and $250. Emergency services have a $125 copay, and primary care visits have no copay, while specialist visits have a copay between $0 and $30. Preventive services like annual exams have no copay, and vision services also have no copay for routine exams and eyewear up to $240 per year. Dental services have a $2,100 annual maximum benefit, with a $30 copay for Medicare dental services. Home health services are covered with no copay, and many other services, like OTC items, have no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $250 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Aetna Medicare Premier (PPO) plan. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $250 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services and Outpatient Substance Abuse Services have copays of $0 and $30, respectively.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Premier (PPO) plan, but requires prior authorization. This benefit has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. 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 (PPO) plan. Emergency Services have a $125 copay with no coinsurance. Urgently Needed Services have a $35 copay with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay with no coinsurance, and Worldwide Emergency Transportation has a $275 copay with no coinsurance.
Primary Care See details
Under the Aetna Medicare Premier (PPO) plan, primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a $35 copay. Physician specialist services have a copay between $0 and $30, while mental health and psychiatric services have a $30 copay. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $35. 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 like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies have a copay. The plan also covers Kidney Disease Education Services with a 20% coinsurance, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay.
Hearing Services See details
The Aetna Medicare Premier (PPO) plan covers hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $30, and eyewear with no copay. Routine eye exams are covered with no copay once per year, and other eye exam services are covered with no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $240 per year.
Dental Services See details
Dental services are covered, with a $2,100 maximum benefit per year, covering Medicare dental services with a $30 copay. 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 are covered by the Aetna Medicare Premier (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Premier (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a coinsurance between 0% and 20%, and 0% respectively.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have 20% coinsurance. 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; however, 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 (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, the sub-services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Premier (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered are not covered.
Other Services See details
The Aetna Medicare Premier (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to $90 every three months. Annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay. Acupuncture, meal benefits, and several other services are not covered.
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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.
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