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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 Upstate NY Area: HV, Capital, CNY, Rochester, WNY. 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 $139.00. 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 $6300.00 (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 $6300.00 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 an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies and preferred mail order. For standard generic drugs, you will pay 24% coinsurance. For preferred brand and non-preferred drugs, you will pay 25% coinsurance. 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 Platinum (PPO) plan offers a wide array of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have a copay depending on the service. Many services, like primary care, preventive services, and vision services, have no copay, offering cost-effective access to essential healthcare. This plan includes coverage for emergency services, ambulance services, and home health services. Dental, hearing, and medical equipment services are included with defined copays or coinsurance. This plan also offers some coverage for prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $250 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 stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $300, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay, and outpatient blood services with no copay. The plan requires prior authorization for these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Platinum (PPO) plan, but requires prior authorization. The plan has an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Platinum (PPO) plan. Ground and air ambulance services have a $300 copay, and there is no 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 Platinum (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $60 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $300 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Individual Sessions for Mental Health and Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services have no copay, and no coinsurance. Chiropractic services have a $15 copay, and Occupational Therapy Services have no coinsurance with a $0 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $30. This plan does not cover Podiatry Services, and Routine Chiropractic Care is not covered.
Preventive Services See details
The Aetna Medicare Platinum (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, including health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, 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
The Aetna Medicare Platinum (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay up to $1700 per year, but does not cover prescription hearing aids - inner ear, outer ear, or over the ear, or OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are limited to one visit per year, and prescription hearing aids are limited to two visits per year.
Vision Services See details
Vision services, including eye exams and eyewear, are covered by the Aetna Medicare Platinum (PPO) plan. Eye exams and eyewear services have no copay, and eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The Aetna Medicare Platinum (PPO) plan covers dental services with a $1,250 annual maximum. 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, and orthodontic services are covered under diagnostic and preventive dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Platinum (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and the coinsurance is 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 20% with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%, both with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Platinum (PPO) plan. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Platinum (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Platinum (PPO) plan covers meal benefits with no copay. Other services like acupuncture, over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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