A non-government entity
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 WI Southern, North Central, Western, Central. 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 $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 $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:
Sign up for Aetna Medicare Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Premier (PPO) plan features an annual drug deductible of $615. For generic medications, members enjoy no copay for Tier 1 preferred generics and Tier 2 generics when using preferred pharmacies or preferred mail order services. If standard pharmacies or standard mail order services are used, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply length. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance across all pharmacies and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, with specialty tier coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers robust coverage for core medical needs, including primary care physician visits and preventive screenings with no copay or coinsurance. Specialist visits, physical therapy, and urgent care require a $35 copay, while inpatient hospital stays have a $325 daily copay for the first six days of acute care and no copay thereafter. Skilled nursing facility stays feature no copay for the first 20 days, and emergency room services are covered with a $130 copay. For everyday wellness, the plan provides routine dental, vision, and hearing exams with no copay, alongside annual allowances of up to $175 for eyewear and $750 per ear for prescription hearing aids. Comprehensive dental services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, while home health services feature no copay. Medical equipment, diagnostic lab work, and outpatient surgeries are also covered with minimal out-of-pocket costs, though acupuncture, podiatry, and over-the-counter items are not covered.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 to 6 of acute stays (with no copay for days 7 and beyond) and a $300 daily copay for days 1 to 6 of psychiatric stays. Prior authorization is required, and hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $325, while observation services have no coinsurance and a $325 copay per stay. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, and outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of $75.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ambulance services with prior authorization, requiring a $270 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Although some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $130 copay—waived if admitted to the hospital within 24 hours—and urgently needed services with a $35 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum benefit with no coinsurance, featuring copays of $130 for emergency or urgent care and $270 for emergency transportation.
Primary Care See details
Primary Care benefits under Aetna Medicare Premier (PPO) feature no copay and no coinsurance for primary care physician visits, and a $35 copay with no coinsurance for specialist, physical therapy, and occupational therapy visits. Mental health, psychiatric, and opioid treatment services require a $40 copay with no coinsurance, while podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic care are not.
Preventive Services See details
Aetna Medicare Premier (PPO) provides partially covered preventive services, with most options like annual physicals and screenings requiring no copay and no coinsurance, though kidney disease education carries a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Premier (PPO), featuring Medicare-covered exams for a $35 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $750 per ear annually with no copay and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Premier (PPO) with no deductibles and no coinsurance. Covered eye exams have a copay ranging from $0 to $35 (including routine exams with no copay) up to a $50 annual maximum, while eyewear is covered with no copay and no coinsurance up to a $175 annual limit.
Dental Services See details
Dental services are partially covered by Aetna Medicare Premier (PPO), which features a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive cleanings, exams, and x-rays. Comprehensive services like restorative care and endodontics are covered with no copay and 20% to 50% coinsurance up to a $1,500 annual limit, though fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Premier (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Premier (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Premier (PPO), with prior authorization required. Diagnostic services carry no coinsurance, featuring no copay for lab work and a $0 to $100 copay for procedures, while radiological services require a $20 copay for X-rays, a minimum 20% coinsurance for therapeutic services, and diagnostic radiological copays starting at $0.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the Aetna Medicare Premier (PPO) plan with no coinsurance, meaning some services are covered, but standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 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 annual wellness exams, screening mammography, and additional gFOBT and FIT screenings. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved