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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 2025, 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 2025.
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 $14.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 Premier (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $5 copay at a preferred pharmacy. For standard generic drugs, you will pay 25% coinsurance regardless of the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay of $300 for days 1-6, and no copay for days 7-90. Outpatient services, primary care, and preventive services often have no copay, with some services like specialist visits and therapies having a copay between $20 and $75. This plan also includes coverage for emergency services, ambulance services, and home health services. Hearing, vision, and dental services are included with no copays for exams and cleanings, with coverage for hearing aids and eyewear up to a certain amount. Additionally, the plan provides coverage for home infusion, dialysis, medical equipment, and skilled nursing facility stays, with different cost-sharing structures like copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a $300 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, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $75 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 Premier (PPO) plan, with a $75 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premier (PPO) plan. Ground Ambulance Services have a $270 copay, while Air Ambulance Services have a 20% coinsurance; however, 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 Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $270 copay.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $35 copay, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered, but have a $40 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers a variety of preventive services. Annual physical exams, Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear, and prescription hearing aids (all types) have no copay, while inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by the Aetna Medicare Premier (PPO) plan, including eye exams with a copay of $0-$35, and eyewear with no copay. Eyewear has a combined maximum of $200 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers dental services including oral exams with no copay, and dental x-rays and cleanings with no copay. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics, and also has a yearly maximum of $2000 for orthodontic 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.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Aetna Medicare Premier (PPO) plan covers Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, but does not cover DME for use outside the home. Prosthetics/Medical Supplies, including Prosthetic Devices and Medical Supplies, are covered with no copay and coinsurance between 0% and 20%. Diabetic Equipment is covered with a coinsurance and copay, and the plan covers Diabetic Supplies with a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests and lab services with a copay between $0 and $100. Diagnostic radiological services have a copay up to $250, and therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier (PPO) plan, but the specific services are not covered. The plan has a copay for the covered services, but the exact amount is not specified in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Premier (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. This plan also covers Other 1 and Other 2 services with no copay. Acupuncture, 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, 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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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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.
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