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Aetna Medicare FL Explorer Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare FL Explorer 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 FL Explorer Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare FL Explorer Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central FL. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare FL Explorer 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 FL Explorer 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 FL Explorer Premier (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 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 FL Explorer Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare FL Explorer Premier (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for days 1-5, and no copay for days 6-90, while outpatient services have copays that range from $0 to $290. Emergency services have a $120 copay, and primary care visits have no copay, and specialist visits have copays between $0 and $35. Preventive services include an annual physical exam with no copay, and hearing and vision services are covered with copays. Dental services have a $35 copay for Medicare-covered services, and other dental services are covered up to a $2,500 annual maximum. The plan also includes coverage for home health services with no copay and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $300 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $290, and Observation Services have a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Individual Sessions for Outpatient Substance Abuse have a $25 copay, and Group Sessions have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance; 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 by the Aetna Medicare FL Explorer Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, Urgently Needed Services has a $20 copay, and Worldwide Emergency Transportation has a $200 copay, with no coinsurance for any of these services.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services are covered with a copay of $25 for individual sessions and $15 for group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $35, and Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with varying copays. 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 are covered with no copay. Prescription hearing aids are covered with a maximum copay of $1700, but prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams, with a copay between $0 and $35, and eyewear with no copay. Routine eye exams are covered with no copay, and you are eligible for one exam per year. Eyewear benefits have a combined maximum of $155 per year for both in-network and out-of-network services.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $35 copay, and other dental services with a $2,500 maximum benefit per year. 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 and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, with no copay. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Equipment is covered, and Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $75, lab services with no copay, and outpatient X-ray services with no copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and diagnostic radiological services have a copay of at most $185.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare FL Explorer Premier (PPO) plan. Although Cardiac Rehabilitation Services are listed as covered, all sub-services are listed as not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $45.00 every three months. Acupuncture, meal benefits, and a variety of other services are not covered.
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