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Aetna Medicare Explorer (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Explorer (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern New Hampshire. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Explorer (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 Explorer (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 Explorer (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 $250.00 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 $9500.00 (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 $9500.00 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 Explorer (PPO) plan has an enhanced alternative drug benefit. The plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Explorer (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find coverage for emergency services, primary care, preventive services, hearing, vision, dental, and home health services. The plan also covers ambulance services, skilled nursing facilities, and home infusion services. This plan includes a $395 copay for the first 7 days of inpatient hospital stays, but no copay for additional days. Outpatient services have varying copays, while many services like primary care visits, routine hearing exams, and dental services have no copay. Additionally, the plan covers some medical equipment, dialysis, and diagnostic services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $395 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $275 for days 1-7 and no copay for days 8-90 for 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 for the Aetna Medicare Explorer (PPO) plan includes coverage for outpatient hospital services with a copay between $0 and $335, observation services with a $395 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Explorer (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer (PPO) plan. Ground ambulance services have a $295 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 Explorer (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $295 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Explorer (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $40 copay, and physician specialist services with a copay between $0 and $40. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, and additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40. However, routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Explorer (PPO) plan covers preventive services, including an annual physical exam with no copay. Other services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies have a copay, while Kidney Disease Education Services have a 20% coinsurance. Several other preventive services are not covered.
Hearing Services See details
Hearing Services include Hearing Exams with a $40 copay, Routine Hearing Exams with no copay for 1 visit every year, Fitting/Evaluation for Hearing Aids with no copay for 1 visit every year, and Prescription Hearing Aids with a copay up to $1700 for 2 visits every year, while OTC Hearing Aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit of $225 every year.
Dental Services See details
Dental services are covered, including 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, with a $0 copay. Medicare dental services have a $40 copay, and there is a $750 maximum plan benefit. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Explorer (PPO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Explorer (PPO) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare Explorer (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Explorer (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $40, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $200, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Explorer (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 not covered by the Aetna Medicare Explorer (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Explorer (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, 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.
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