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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 Southwest 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 the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For all other tiers, you will pay coinsurance of 24% or 25% depending on the drug and pharmacy. Once your total drug costs reach $2000, 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 depending on the specific service. This plan also covers emergency services, primary care, preventive services, and home health services, often with no copay. Vision and dental services are included, with no copay for many services but with annual maximums. Additional benefits include hearing exams and hearing aids, with copays and maximums, as well as medical equipment and home infusion services with varying coinsurance. The plan also covers skilled nursing facilities, diagnostic and radiological services, and offers a quarterly allowance for over-the-counter items. However, some services like cardiac rehabilitation and certain hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For days 1-6, the copay is $275, and there is no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay. 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, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $275, observation services have a $275 copay, ambulatory surgical center services have no copay, individual outpatient substance abuse sessions have a $30 copay, group outpatient substance abuse sessions have a $25 copay, and outpatient blood services have no 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. Ground ambulance services have a $275 copay, while air ambulance services have 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 under the Aetna Medicare FL Explorer Premier (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $15 copay and no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, while Worldwide Emergency Transportation has a $275 copay and 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 $25 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. Physical therapy and speech-language pathology services have a $25 copay, while 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, while additional preventive services are covered, including health education, additional sessions of smoking and tobacco cessation counseling, wigs for hair loss related to chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $40 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids (all types) are covered with a maximum copay of $1700. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers vision services including eye exams with a copay of $0-$40, and eyewear with no copay, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $155 per year. Routine eye exams and other eye exam services have no copay.
Dental Services See details
Dental services include coverage for 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 with no copay, and a maximum plan benefit of $2,500 per year. Orthodontic services are covered under Diagnostic and Preventive Dental, while 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 for a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan. This plan requires prior authorization, and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare FL Explorer Premier (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, with no copay. Diabetic Equipment has a coinsurance between 0% and 20%, depending on the service, and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $75, and lab services with no copay. Therapeutic Radiological Services have a coinsurance of at most 20%, while Diagnostic Radiological Services have a copay of at most $185. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan with no copay and no coinsurance, however, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare FL Explorer Premier (PPO) plan. While Cardiac Rehabilitation Services are generally covered, the specific services of 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 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 per day; additional days beyond Medicare-covered and non-Medicare-covered stays 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 of $45 every three months. Other services like acupuncture, meal benefits, and many other services are not covered.
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