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Aetna Medicare Platinum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Platinum (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Platinum (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Platinum (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in New Jersey Counties: All. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Platinum (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 Platinum (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 Platinum (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $157.00. 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 $450.00 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 Platinum (PPO) plan has a $450 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail-order pharmacies, but have a $12 copay at standard pharmacies and standard mail-order pharmacies. You will enter the catastrophic coverage phase after your total drug costs reach $2000, where you will pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Platinum (PPO) plan offers a range of benefits with varying costs. For hospital stays, you'll pay a $200 copay per admission. Outpatient services have copays ranging from $0 to $300, while emergency services have copays from $30 to $75. This plan includes no copays for primary care, preventive services, hearing exams, vision services, and dental services, but may have coinsurance for other services. Home health services have no copay, while skilled nursing facilities have a copay depending on the length of stay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $200 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $300, observation services have a $200 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services, and outpatient blood services are also covered, with no copay for outpatient blood services, and no copay for individual or group sessions for outpatient substance abuse.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Platinum (PPO) plan, but requires prior authorization. The plan has a $60 copay for this benefit.
Ambulance and Transportation Services See details
The Aetna Medicare Platinum (PPO) plan covers ambulance services with no coinsurance, but requires a $300 copay for both ground and air ambulance services. 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 Platinum (PPO) plan. Emergency Services have a $75 copay, Urgently Needed Services have a $30 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $75 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Platinum (PPO) plan covers primary care physician services, physician specialist services, and physical therapy and speech-language pathology services with no copay. Chiropractic Services have a $15 copay, while mental health and psychiatric services have a $0 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $30.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services are covered as well. Kidney Disease Education Services have a 20% coinsurance, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Aetna Medicare Platinum (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids are covered with a maximum copay of $1,700, and inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Platinum (PPO) plan covers vision services, including eye exams, routine eye exams, and other eye exam services with no copay. The plan also covers eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay, and a combined maximum benefit of $150 every year.
Dental Services See details
The Aetna Medicare Platinum (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic services, with no copay. Other covered services include prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $750 annual maximum for all dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Platinum (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 0-20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Aetna Medicare Platinum (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with no copay, lab services with no copay, diagnostic radiological services with a copay of up to $150, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Platinum (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 not covered by the Aetna Medicare Platinum (PPO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Platinum (PPO), but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $214 per day.
Other Services See details
Other Services includes a meal benefit with no copay, but acupuncture, over-the-counter items, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered. Other services such as annual wellness exam and screening mammography, and gFOBT, FIT are covered with no copay.
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