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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 North FL, 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 $6200.00 (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 $6200.00 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 will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare FL Explorer Premier (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency and primary care services are also covered, with some services having no copay. Preventive, hearing, vision, and dental services are included, with specific copays and annual maximums for some services. Additional benefits include home infusion, dialysis, and medical equipment, with associated copays or coinsurance. Home health services and skilled nursing facilities are covered, with specific cost-sharing structures. The plan also covers other services like OTC items and some therapies.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has the same cost structure. Additional days and non-medicare covered stays 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 $295, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $30 copay for individual sessions and a $25 copay for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare FL Explorer Premier (PPO) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan. Ground ambulance services have a $215 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $15 copay with no coinsurance, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay with no coinsurance, and Worldwide Emergency Transportation has a $215 copay with no coinsurance.
Primary Care See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, and physician specialist services with a copay between $0 and $40. Mental health specialty services, psychiatric services, and opioid treatment program services have varying copays depending on the specific service, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like health education, additional smoking cessation counseling, wigs for hair loss, and fitness benefits. Kidney disease education services have a 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a copay of up to $1700 for all types of prescription hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$40, while routine eye exams are limited to one per year with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, frames, and upgrades, are covered with no copay, with a combined maximum benefit of $155 per year.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare dental services, and a $2,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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. Specifically, the plan covers Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare FL Explorer Premier (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and include Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies. 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, with a copay for Medicare-covered diagnostic procedures/tests and therapeutic and diagnostic radiological services, ranging from $0 to $185 depending on the service. Lab services have no copay, while therapeutic radiological services have a 20% coinsurance.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, but require prior authorization. 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 Other 1 and Other 2 services with no copay. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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