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Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Premier (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Western NY. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $500.00 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 Premier (PPO) prescription drug plan features an annual drug deductible of $500. For Tier 1 preferred generic and Tier 2 generic medications, you will enjoy no copay when filling your prescriptions through a preferred pharmacy or preferred mail-order service. If you use a standard pharmacy or standard mail order, Tier 1 drugs have a copay starting at $2, and Tier 2 drugs have a copay starting at $12. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, and Tier 4 non-preferred drugs carry a 25% coinsurance across all pharmacy and mail-order options. Specialty Tier 5 prescriptions have a 27% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits and diagnostic procedures, you will generally pay anywhere from no copay up to a $35 copay with no coinsurance. Inpatient hospital stays require a $300 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $115 copay that is waived if you are admitted. This plan also includes comprehensive supplemental benefits, such as dental care with no copay or coinsurance up to a $2,000 annual maximum. Vision and hearing services are covered with no coinsurance, featuring no copays for routine exams and eyewear, and hearing aid copays ranging from no copay up to $1,700. For recovery needs, skilled nursing facility stays have no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required, and upgrades or non-Medicare-covered stays are not covered. For acute stays, there is a $300 daily copay for days 1 to 6 and no copay for days 7 and beyond. Psychiatric stays require a $346 daily copay for days 1 to 6 and no copay for days 7 to 90, with additional psychiatric days not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $300, observation services have a $300 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of either $80.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance. Transportation services, including trips to plan-approved or any health-related locations, are not covered under this plan.
Emergency Services See details
Emergency services under the Aetna Medicare Premier (PPO) are covered 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 services are covered up to a $250,000 limit with no coinsurance and copays of $115 for emergency or urgent care and $300 for emergency transportation.
Primary Care See details
Aetna Medicare Premier (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Therapy, psychiatric, and mental health services are covered with copays ranging from $25 to $35 and no coinsurance, while chiropractic care is partially covered (excluding other chiropractic services) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Premier (PPO), featuring no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes self-management, and select supplemental benefits like memory fitness and chemotherapy wigs. Kidney disease education is covered with no copay and a 20% coinsurance, while other services such as weight management, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Premier (PPO) partially covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $35 copay and annual routine exams and fitting evaluations with no copay. Up to two prescription hearing aids per year are covered with copays ranging from $0 to $1,700, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no coinsurance, featuring a $0 to $35 copay for eye exams and no copay for eyewear. Routine eye exams and corrective eyewear, including contacts and eyeglasses, are covered with no copays or deductibles, subject to annual maximum limits of $50 and $250 respectively.
Dental Services See details
Aetna Medicare Premier (PPO) partially covers dental services up to a $2,000 annual maximum for both in-network and out-of-network care, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Premier (PPO) covers Dialysis Services with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Premier (PPO) plan with no copay, although prior authorization is required. Depending on the item, coinsurance ranges from no coinsurance up to 20% for durable medical equipment, prosthetics, medical supplies, and diabetic equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Premier (PPO), though prior authorization is required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $35, lab services have no copay, outpatient X-rays require a $25 copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Premier (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Premier (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Premier (PPO) partially covers other services, offering no copay and no coinsurance for chronic illness meal benefits, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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