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Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $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 Signature (PPO) plan features an Enhanced Alternative drug benefit with a $615.00 annual prescription drug deductible. Once this deductible is met, you will pay no copay for Tier 1 preferred generic drugs at preferred pharmacies or through preferred mail order, while standard options require a $12.00 copay. For higher tiers, members pay a 24% coinsurance for Tier 2 standard generics and a 25% coinsurance for Tier 3 preferred brand and Tier 4 non-preferred drugs. These cost-sharing rates apply during the initial coverage phase until your total drug costs reach $2,100.00. Once your yearly out-of-pocket drug costs reach this $2,100.00 threshold, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. Individuals who qualify for the low-income subsidy may also see their Part D costs reduced to $0.00.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care visits and most preventive care. Specialist visits require a $40 copay, while inpatient hospital stays feature a $375 daily copay for the first seven days of acute care with no coinsurance. Emergency room visits have a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also provides generous supplemental benefits, including routine dental cleanings, annual eye exams, and hearing fittings with no copay and no coinsurance. Members also benefit from a $150 annual eyewear allowance and up to $1,250 per ear annually for prescription hearing aids. However, certain services such as cardiac rehabilitation, acupuncture, and over-the-counter items are not covered under this plan.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) partially covers inpatient hospital services with no coinsurance, featuring a $375 daily copay for days 1-7 of acute care (no copay for days 8-90) and days 1-6 of psychiatric care (no copay for days 7-90). Upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Signature (PPO) with no coinsurance, featuring no copays for outpatient blood and ambulatory surgical center services. Members will pay a $40 copay for outpatient substance abuse sessions and copays ranging from $0 to $375 for outpatient hospital and observation services, with prior authorization required for most benefits.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) partially covers ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $265 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with both requiring prior authorization.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $130 copay and no coinsurance, and this copay 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, urgent, and transportation services are covered up to a $250,000 limit with copays ranging from $130 to $265 and no coinsurance.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care visits with no copay and no coinsurance, while specialists, therapists, and psychiatric sessions require a $40 copay and no coinsurance. Telehealth services have a range from no copay to a $40 copay with 20% coinsurance, podiatry is not covered, and some chiropractic services are covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Signature (PPO), with most benefits like annual physicals, fitness programs, and screenings available with no copay and no coinsurance. Kidney Disease Education requires a 20% coinsurance, while several sub-services are not covered, including In-Home Safety Assessments, Personal Emergency Response Systems (PERS), and Weight Management Programs.
Hearing Services See details
Aetna Medicare Signature (PPO) partially covers hearing services, providing hearing exams, fitting evaluations, and prescription hearing aids with no copay and no coinsurance, up to a $1,250 maximum per ear every year. However, OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers annual routine and diabetic eye exams with no copay and no coinsurance, up to a maximum benefit of $50 per year. The plan also covers eyewear—including contact lenses, eyeglasses, frames, and upgrades—with no copay and no coinsurance up to a combined maximum limit of $150 annually.
Dental Services See details
Dental services are partially covered under Aetna Medicare Signature (PPO), offering routine exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental services require a $40 copay and no coinsurance. However, fluoride, orthodontics, restorative, endodontic, periodontic, prosthodontic, implant, maxillofacial, and oral surgery services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under Aetna Medicare Signature (PPO) and require prior authorization. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Signature (PPO) plan with no copays for any covered items, including diabetic therapeutic shoes and inserts. Members will pay between no coinsurance and 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic supplies, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Signature (PPO) with prior authorization required. Diagnostic procedures require a copay of up to $40 and no coinsurance, lab services have no copay or coinsurance, diagnostic radiology has a copay of up to $295 with no coinsurance, outpatient X-rays require a $40 copay, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Signature (PPO) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage. Since these services are not covered, there are no copays or coinsurance rates applicable.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a daily copay of $10 for days 1-20 and $218 for days 21-100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Signature (PPO), which offers annual wellness exams, screening mammographies, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, meal benefits, and dual-eligible SNPs with highly integrated services are not covered.
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