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Aetna Medicare Signature Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature Giveback (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select New Orleans and Baton Rouge Parishes. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature Giveback (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 Signature Giveback (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 Signature Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced 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 $615.00 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 $13900.00 (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 $13900.00 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 Signature Giveback (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using preferred pharmacies or preferred mail-order services for one, two, or three-month fills. Standard pharmacies and standard mail-order services charge a copay ranging from $2 to $6 for Tier 1, and $12 to $36 for Tier 2 medications. For higher-tier prescription drugs, cost sharing is based on a coinsurance percentage rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for all pharmacy and mail-order options. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature Giveback (PPO) provides comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. If you require specialist visits, you will face a copay ranging from no copay up to $55. For hospital care, outpatient services have no coinsurance and copays up to $450, while inpatient acute stays require a $388 daily copay for the first seven days with no copay thereafter. This plan also includes valuable dental, vision, and hearing benefits, featuring no copays and no coinsurance for preventive dental cleanings, routine eye exams, and annual hearing tests. Comprehensive dental services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, while prescription hearing aids and eyewear are covered up to annual allowance limits with no copays. For medical equipment and dialysis, you will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature Giveback (PPO) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute stays require a $388 daily copay for days 1 through 7 with no copay thereafter, while psychiatric stays require a $407 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Aetna Medicare Signature Giveback (PPO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $450 for hospital services and $388 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Signature Giveback (PPO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by the Aetna Medicare Signature Giveback (PPO) and require prior authorization, featuring a $295 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Aetna Medicare Signature Giveback (PPO) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency care is covered up to a $250,000 lifetime maximum with no coinsurance and copays ranging from $115 to $295.
Primary Care See details
Primary care benefits under the Aetna Medicare Signature Giveback (PPO) include primary care visits with no copay and no coinsurance, and specialist visits with a $0 to $55 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $35 copay with no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Aetna Medicare Signature Giveback (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physicals, glaucoma screenings, and select supplemental benefits like memory fitness, health education, and chemotherapy wigs. Kidney disease education is covered with no copay and a 20% coinsurance, whereas several services, including weight management, personal emergency response systems, and nutritional benefits, are not covered.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Signature Giveback (PPO), with Medicare-covered exams requiring a $55 copay and no coinsurance, while routine exams and fitting evaluations are available with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Signature Giveback (PPO) with no deductibles or coinsurance, featuring eye exams with a $0 to $55 copay and a $50 annual maximum. Covered eyewear, including eyeglasses and contact lenses, has no copay up to a combined annual maximum benefit of $100.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature Giveback (PPO), offering preventive care like cleanings and exams with no copay and no coinsurance, and various comprehensive services with no copay and 20% to 50% coinsurance up to a $1,500 annual limit. Medicare-covered dental has a $55 copay and no coinsurance, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Signature Giveback (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature Giveback (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature Giveback (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts are covered with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature Giveback (PPO) with prior authorization required. Medicare-covered lab services and outpatient X-rays have no copay, diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Signature Giveback (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature Giveback (PPO) with no coinsurance, though copays apply for specific treatments. You will pay a $25 copay for cardiac and intensive cardiac rehabilitation, a $15 copay for pulmonary rehabilitation, and a $20 copay for supervised exercise therapy (SET).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature Giveback (PPO) partially covers other services, offering chronic illness meal benefits, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered under this benefit.
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