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Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (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 (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Central and Southwest Virginia counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 (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 (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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $9900.00 (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 $9900.00 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 (PPO) plan has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when filled through a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance regardless of the pharmacy type you choose. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs require 25% coinsurance. Tier 5 specialty drugs also have a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust coverage with many key services featuring no copay, including preventive annual physicals, routine dental cleanings, and routine eye and hearing exams. When visiting the doctor, you will pay a low $15 copay for primary care visits and up to a $55 copay for specialists, with no coinsurance required for these services. Emergency care is covered with a $115 copay, which is waived if you are admitted, and inpatient hospital stays feature a $340 daily copay for the first eight days. Other essential benefits like home health services, clinical lab tests, and durable medical equipment are available with no copays, though some equipment and dialysis services require a 20% coinsurance. Skilled nursing facility care is also highly accessible, requiring no copay for the first 20 days of your stay. While the plan covers a wide array of medical needs, it is important to note that transportation, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) partially covers inpatient hospital services with no coinsurance, featuring a $340 daily copay for days 1-8 of acute stays (with no copay for additional days) and a $260 daily copay for days 1-8 of psychiatric stays (with no copay for days 9-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $340 copay, observation services with a $340 copay per stay, and outpatient substance abuse sessions with a $40 copay. Ambulatory surgical center and outpatient blood services are covered with no copays and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Signature (PPO), requiring prior authorization for ambulance services which cost a $275 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care doctor visits for a $15 copay and no coinsurance, and specialist visits for no copay to a $55 copay and no coinsurance. Physical, occupational, speech, and mental health therapies are covered with copays ranging from $35 to $55 and no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance for annual physicals, screenings, and health education, though kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered, as services such as in-home safety assessments, medical nutrition therapy, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Signature (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $55 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear annually, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles and no coinsurance, offering routine eye exams and eyewear with no copay. Other covered exams have a copay of up to $55, with annual plan maximums of $50 for exams and a combined $100 for contacts and eyeglasses.
Dental Services See details
Dental services are covered under the Aetna Medicare Signature (PPO) with a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for routine cleanings, oral exams, and X-rays. This benefit is only partially covered, as fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays for durable medical equipment (DME), prosthetics, and diabetic shoes or inserts. Depending on the item, coinsurance ranges from no coinsurance to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices carry a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services, with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests carry a $0 to $100 copay with no coinsurance, and radiological services range from no copay for diagnostic radiology and a $15 copay for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Aetna Medicare Signature (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (PPO) with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays of $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by Aetna Medicare Signature (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) provides partial coverage for other services, offering annual wellness exams, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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