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Aetna Medicare FL Explorer Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare FL Explorer 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 FL Explorer Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare FL Explorer 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 FL Explorer 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 FL Explorer 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 FL Explorer 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 FL Explorer Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, while standard pharmacies charge a $12 copay. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug tier. After 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 FL Explorer Premier (PPO) plan offers a wide range of benefits, including inpatient hospital care with a copay, outpatient services, and emergency care. You will have no copay for primary care physician visits, preventive services such as an annual physical, and many other services, including dental, vision, and hearing exams. The plan also covers home health services with no copay, and offers additional benefits such as coverage for OTC items. This plan has copays for specific services, such as outpatient services, ambulance services, and specialist visits. You may also have to pay coinsurance for some services, including air ambulance and dialysis services. Other services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $290 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered with a $290 copay for days 1-6 and no copay for days 7-90, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 individual sessions having a $30 copay and group sessions having a $25 copay, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare FL Explorer Premier (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $250 copay, and air ambulance services with 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 under the Aetna Medicare FL Explorer Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a copay between $0 and $30. Mental health specialty services and psychiatric services have a $30 copay for individual sessions and a $25 copay for group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $35. Opioid treatment program services have a $30 copay.
Preventive Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include health education, additional sessions of smoking and tobacco cessation counseling, wigs for hair loss related to chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay, and Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing services include coverage for hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription Hearing Aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $30, and routine eye exams and other eye exam services are covered with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Orthodontics is not covered, and there is a $1,000 maximum benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but require Prior Authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare FL Explorer Premier (PPO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items. Diabetic Equipment is covered with a coinsurance between 0% and 20% for Diabetic Supplies, and no coinsurance for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $75, and lab services with no copay. Radiological services are also covered, with diagnostic radiological services having a maximum copay of $185, therapeutic radiological services with a minimum coinsurance of 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan with no copay and no coinsurance. 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 FL Explorer Premier (PPO) plan. While Cardiac Rehabilitation Services are generally covered, specific services like 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 by the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $45 every three months, as well as 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.
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