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Aetna Medicare Prime Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime Giveback (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Prime Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Prime Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Counties: BR, HT, MR, MN, MO, PS, SM, SX, UN, WR. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Prime Giveback (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 Prime Giveback (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 Prime Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1000.00 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 $13900.00 (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 $13900.00 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 Prime Giveback (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, low copays apply, starting at just $2 for Tier 1 and $12 for Tier 2 medications. Higher-tier prescription drugs require coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all network pharmacy and mail-order channels. These cost-sharing percentages apply to one, two, or three-month fills, with the exception of specialty medications which are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Prime Giveback (PPO) plan offers comprehensive coverage for essential medical services with no coinsurance for inpatient stays, outpatient hospital visits, and primary care. Doctor visits are highly affordable, requiring a $10 copay for primary care and no copay to a $45 copay for specialists. Inpatient hospital stays require a daily copay for the first six days, followed by no copay for subsequent days. Routine preventive care, annual physicals, and routine vision and hearing exams are fully covered with no copay and no coinsurance. Basic dental services like cleanings and x-rays also feature no copay, although comprehensive dental treatments are not covered under this plan. For durable medical equipment and dialysis, you will pay no copay alongside a coinsurance of up to 20 percent.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Prime Giveback (PPO) with no coinsurance, though prior authorization is required. For acute stays, you pay a $365 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $346 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Prime Giveback (PPO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $365 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $45 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Prime Giveback (PPO) plan with a copay of either $60.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Prime Giveback (PPO) covers ground and air ambulance services with a $300 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Prime Giveback (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $300.
Primary Care See details
Aetna Medicare Prime Giveback (PPO) covers primary care visits with a $10 copay and specialist visits with a $0 to $45 copay, both featuring no coinsurance. Physical, occupational, speech, mental health, and psychiatric services are covered with copays ranging from $35 to $45 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Prime Giveback (PPO) with no copay and no coinsurance for annual physicals, fitness benefits, and screenings, while kidney disease education requires no copay and a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Prime Giveback (PPO) covers hearing services, including Medicare-covered exams for a $45 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays up to $1,700, while inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Aetna Medicare Prime Giveback (PPO) covers vision services with no deductibles and no coinsurance, offering routine eye exams with no copay and other exams with copays ranging from $0 to $45. Eyewear, including contacts and eyeglasses, is also covered with no copay and no coinsurance up to a $100 combined annual limit.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Prime Giveback (PPO), featuring Medicare-covered dental care for a $45.00 copay and no coinsurance. Preventive services like cleanings, oral exams, and x-rays are covered with no copay and no coinsurance, but comprehensive treatments such as restorative, endodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Prime Giveback (PPO) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Prime Giveback (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Prime Giveback (PPO) with no copay, though prior authorization is required. Covered durable medical equipment, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, while prosthetic devices and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Prime Giveback (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and copays ranging from no copay up to $45 for diagnostic tests and lab work. Radiological services require a $45 copay for outpatient X-rays, a minimum 20% coinsurance for therapeutic services, and copays starting at no copay for diagnostic radiology.
Home Health Services See details
Aetna Medicare Prime Giveback (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the Aetna Medicare Prime Giveback (PPO) with no coinsurance, though copays may apply. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Giveback (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Prime Giveback (PPO), providing a chronic illness meal benefit, annual wellness exams, screening mammographies, and additional gFOBT/FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered under this benefit.
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