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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 Northern California. 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 an annual prescription drug deductible of $615.00. After meeting this deductible, Tier 1 preferred generic drugs have no copay when using a preferred pharmacy or preferred mail-order service, while standard options require a $12.00 copay. For Tier 2 standard generic drugs, you will pay a 24% coinsurance across all pharmacy and mail-order channels. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both require a 25% coinsurance during the initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive coverage with predictable costs, featuring no copay for primary care visits and a $50 copay for specialist visits. For hospital stays, members pay a $335 daily copay for the first 7 days of acute inpatient care and no copay for subsequent days. Emergency room visits require a $130 copay, which is waived if admitted, while urgent care is available for a $40 copay. Routine preventive care, annual vision and hearing exams, and standard dental cleanings are fully covered with no copays or coinsurance. The plan also features a $150 annual eyewear allowance and up to a $1,250 annual hearing aid benefit per ear. While home health services require no copay, other services like dialysis and certain medical equipment require up to a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $335 daily copay for days 1 through 7 of acute stays and days 1 through 6 of psychiatric stays, followed by no copay for subsequent days. Sub-services not covered under this plan include upgrades, non-Medicare-covered stays, and additional days for psychiatric care.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring copays of $0 to $375 for outpatient hospital services, $335 per stay for observation services, and $40 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization benefits with a copay ranging from $70 to $145 and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Signature (PPO) with a $285 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Prior authorization is required for ambulance services, and transportation services are not covered.
Emergency Services See details
Emergency services are covered under Aetna Medicare Signature (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency care is covered up to a $250,000 lifetime limit with copays ranging from $130 to $285 and no coinsurance.
Primary Care See details
Aetna Medicare Signature (PPO) partially covers primary care benefits, excluding podiatry services and routine chiropractic care. Covered services include primary care visits with no copay and no coinsurance, specialist visits for a $50 copay and no coinsurance, and telehealth services for a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Signature (PPO) covers annual exams, screenings, and wellness programs with no copay and no coinsurance, while kidney education requires a 20% coinsurance and no copay. Additional preventive benefits are partially covered, excluding in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home modifications, and counseling.
Hearing Services See details
Aetna Medicare Signature (PPO) partially covers hearing services, providing annual routine hearing exams, fitting evaluations, and general prescription hearing aids with no copays, no coinsurance, and a $1,250 annual maximum benefit per ear. OTC hearing aids, as well as 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 Signature (PPO) with no copay, coinsurance, or deductible for eye exams and eyewear. Members are covered for one routine eye exam per year with up to a $50 allowance, as well as a $150 annual allowance for eyeglasses and contact lenses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), which features no copay and no coinsurance for oral exams, cleanings, and x-rays, and a $50 copay with no coinsurance for Medicare-covered dental services. Specific sub-services including fluoride, orthodontics, restorative, endodontics, periodontics, prosthodontics, implants, maxillofacial prosthetics, adjunctive general services, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers Home Infusion bundled Services with prior authorization, which includes a $35 copay and no coinsurance for Medicare Part B insulin drugs. Other covered Part B chemotherapy, radiation, and clinical drugs require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Aetna Medicare Signature (PPO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Signature (PPO) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with prior authorization required. These covered benefits feature no copays, and coinsurance ranges from no coinsurance up to 20% depending on the service.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic tests with no copay. Members will pay a $40 copay for outpatient X-rays, up to a $200 copay for diagnostic radiological services, and 20% coinsurance for therapeutic radiological services.
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
Aetna Medicare Signature (PPO) does not cover Cardiac Rehabilitation Services, as none of the sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered. Since these services are not covered, there are no copays or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) partially covers Skilled Nursing Facility (SNF) services with a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. Prior authorization is required, and additional days beyond Medicare-covered SNF care are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering select benefits like annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. However, acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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