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Aetna Medicare Preferred (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Preferred (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Puget Sound Area and Spokane County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Preferred (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 Preferred (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 Preferred (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 $450.00 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 $14000.00 (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 $14000.00 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 Preferred (PPO) plan has an enhanced alternative drug benefit. The plan has a $450 deductible for prescription drugs. In the initial coverage phase, after you pay the deductible, you will pay a $0 copay for preferred generic drugs at preferred and mail order pharmacies. For other tiers, you will pay coinsurance, such as 22% for standard generic drugs, 25% for preferred brand drugs, and 27% for non-preferred drugs. After your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Preferred (PPO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, and outpatient services often have copays, but some services like ambulatory surgical centers have no copay. This plan also includes coverage for primary care, preventive, hearing, vision, and dental services, many of which have no copay. Additional benefits include ambulance, emergency, and home health services, with copays or coinsurance depending on the service. Diagnostic, radiological, and skilled nursing facility services are also covered with copays or coinsurance. However, some services like cardiac rehabilitation and certain other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric has the same cost sharing. Additional days for Inpatient Hospital-Acute are covered with no copay. 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, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $390, Observation Services have a $395 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Preferred (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Preferred (PPO). Ground Ambulance Services have a $255 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Preferred (PPO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Services have a $110 copay for Worldwide Emergency and Urgent Coverage, and a $255 copay for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are partially covered with a $15 copay for routine care, but routine chiropractic care is not covered. Occupational Therapy Services have a $20 copay. Physician Specialist Services have a copay between $0 and $55. Mental Health Specialty Services, including individual and group sessions, have a $40 copay. Other Health Care Professional services have a copay between $0 and $55. Psychiatric Services, including individual and group sessions, have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $55. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and additional preventive services with copays listed as other services. The plan also covers other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $1250 per year, per ear, with no copay for prescription hearing aids (all types). OTC hearing aids, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Preferred (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear each have no copay, and eyewear has a combined maximum plan benefit of $165 per year.
Dental Services See details
The Aetna Medicare Preferred (PPO) plan covers dental services, 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 no copay. This plan has an annual maximum benefit of $1,000 for both in-network and out-of-network services, and does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Preferred (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and 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 by the Aetna Medicare Preferred (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no coinsurance and a coinsurance of 20% maximum, and Diabetic Therapeutic Shoes/Inserts have no copay. 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, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $325, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Preferred (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 Preferred (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Preferred (PPO) plan, with a $0 copay for days 1-20, and a $175 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services are partially covered by the Aetna Medicare Preferred (PPO) plan, with acupuncture, over-the-counter items, meal benefits, 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 not covered. Other 1 and Other 2 services are covered with no copay.
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