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 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 IN Southern. 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 $19.00. 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 Premier (PPO) plan has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you have no copay at preferred pharmacies and preferred mail order, with a $12.00 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance depending on the tier.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers a wide range of benefits with varying cost-sharing options. Inpatient hospital stays have a copay, while outpatient services and many preventive services have no copay. Emergency services, primary care, and vision services also have benefits with no copay. The plan covers ambulance services, hearing aids, and dental services with copays. Other services like home health, medical equipment, and skilled nursing facilities have no copay or a coinsurance. Certain services, like home infusion, dialysis, and diagnostic services, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-7, and no copay for days 8-90, while Inpatient Hospital Psychiatric has a $250 copay for days 1-7, and no copay for days 8-90. 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 include outpatient hospital services with a copay between $0 and $275, observation services with a $275 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $75 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, with a $75 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premier (PPO) plan. Ground ambulance services have a $280 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations 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 $280 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $30 copay. This plan also covers physician specialist services with a copay between $0 and $35, and mental health specialty services and psychiatric services with a $40 copay for individual and group sessions. Additionally, physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have 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 preventive services, including an annual physical exam with no copay. Other preventive services are covered, with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services has 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 are covered with no copay. Prescription hearing aids (all types) are covered with a maximum plan benefit of $750 per ear every year, but prescription hearing aids - inner ear, outer ear, and over the ear, are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier (PPO) plan covers vision services including eye exams with a copay of $0-$35, and eyewear with no copay. Routine eye exams are covered with no copay, and other eye exam services are covered with no copay. Eyewear has a combined maximum benefit of $150 per year for both in-network and out-of-network services.
Dental Services See details
Dental services are covered, with a $35 copay for Medicare dental services, and a $1,750 annual maximum benefit. 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), prosthodontics (fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Premier (PPO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0% to 20% coinsurance. Diabetic Supplies have a 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $75, lab services with no copay, and outpatient X-ray services with a $10 copay. Diagnostic radiological services have a copay up to $250, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare 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 covered under the Aetna Medicare Premier (PPO) plan, but specific details on cost sharing are not provided. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Premier (PPO) plan, but prior authorization is required. There is no copay for days 1-20, but there is a $214 copay for days 21-100, and additional days beyond Medicare-covered are not covered.
Other Services See details
Under Other Services, 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, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items and meal benefits have no copay. Other 1 and Other 2 services also have no copay.
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