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Aetna Medicare Signature Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature 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 Signature Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Eastern and Sandhills NC. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature 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 Signature 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 Signature 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 $30.00. You must continue to pay paying your reduced 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 $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 $8500.00 (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 $8500.00 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 Giveback (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred retail pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services carry low copays starting at $2 for Tier 1 and $12 for Tier 2 one-month supplies. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance across all pharmacy options. Specialty tier medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature Giveback (PPO) plan offers robust medical coverage with no copay for primary care doctor visits and low copays ranging from $0 to $50 for specialist consultations. Hospital stays feature daily copays of $388 for the first seven days of acute care with no coinsurance, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient surgical services and routine lab tests are also highly accessible with no copays. Essential lifestyle benefits are well-supported, offering no copay for routine vision and hearing exams alongside annual allowances for eyewear and hearing aids. Dental care is covered up to a $1,000 annual maximum with no copay and 0% to 50% coinsurance for preventive and comprehensive services. Home health visits feature no copay, and skilled nursing facility stays require no copay for the first 20 days of care.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Aetna Medicare Signature Giveback (PPO) with no coinsurance, requiring prior authorization and daily copays of $388 for days 1-7 of acute stays and $260 for days 1-8 of psychiatric stays, with no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature Giveback (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require a copay of $0 to $388, while outpatient substance abuse sessions have a $40 copay, with no coinsurance and prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Signature Giveback (PPO) plan with a copay of either $105.00 or $110.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Signature Giveback (PPO) covers ground ambulance services with a $275 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. While transportation is technically covered, only some services are covered as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Signature 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, and urgent care with a $40 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 limit with no coinsurance, requiring a $115 copay for emergency or urgent care and a $275 copay for emergency transportation.
Primary Care See details
Aetna Medicare Signature Giveback (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies require copays between $35 and $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services offered by Aetna Medicare Signature Giveback (PPO) are partially covered, with most services like annual physicals, fitness benefits, and screenings requiring no copay and no coinsurance, while kidney disease education has no copay but a 20% coinsurance. Sub-services not covered under this plan include 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
Hearing services are partially covered by the Aetna Medicare Signature Giveback (PPO), offering Medicare-covered exams for a $50 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature Giveback (PPO) with no deductible and no coinsurance, featuring a $0 to $50 copay for eye exams and no copay for eyewear. The plan provides up to a $50 annual maximum for eye exams, including one routine exam per year, and a combined $100 annual maximum for eyewear.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Signature Giveback (PPO), featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for preventive and comprehensive benefits up to a $1,000 annual maximum. Specific excluded services that are not covered include fluoride treatments, implants, orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Aetna Medicare Signature Giveback (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy apply. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Signature Giveback (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature Giveback (PPO) with no copay and coinsurance ranging from no coinsurance to 20% depending on the service. Covered items include durable medical equipment, prosthetics, and diabetic supplies, though prior authorization is required and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Signature Giveback (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic tests carry a copay of $0 to $200 with no coinsurance, lab services and outpatient X-rays feature no copay, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Signature Giveback (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no coinsurance under the Aetna Medicare Signature Giveback (PPO) plan, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Signature Giveback (PPO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a 3-day prior hospital stay is not required, additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Signature Giveback (PPO), offering over-the-counter (OTC) items up to $30 every three months, annual wellness exams, and additional colorectal screenings with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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