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Aetna Medicare Preferred (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Preferred (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Preferred (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Preferred (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Greater Portland Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Preferred (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 Preferred (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 Preferred (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 $12000.00 (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 $12000.00 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:
Sign up for Aetna Medicare Preferred (PPO)
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Drug Coverage
The Aetna Medicare Preferred (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 pharmacy used. For preferred generic drugs, you will pay no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies or standard mail order. For standard generic and brand name drugs, you will pay 22% or 25% coinsurance, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Preferred (PPO) plan provides coverage for a wide range of healthcare services, including inpatient and outpatient care, with varying copays depending on the specific service. Many services, such as primary care visits, preventive services, and dental services, have no copay. Other services like ambulance, emergency services, and specialist visits have copays, and some services like durable medical equipment and dialysis have coinsurance. This plan also offers additional benefits such as hearing and vision coverage, including hearing exams, eyewear, and a maximum annual allowance for hearing aids. There are also some services that are not covered, such as additional hours of care, personal care services, and certain types of dental work.
Inpatient Hospital See details
The Aetna Medicare Preferred (PPO) plan covers inpatient hospital services, including acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $405 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for both acute and psychiatric care are not covered, and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a $425 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Preferred (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Preferred (PPO). Ground ambulance services have a $270 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, Worldwide Emergency Coverage, and Worldwide Urgent Coverage each have a $110 copay, while Worldwide Emergency Transportation has a $270 copay; all have no coinsurance. The copay for Emergency Services is waived if admitted to the hospital.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $10 copay (excluding routine care), and Occupational Therapy Services with a $35 copay. Physician Specialist Services have a copay between $0 and $45, while Mental Health Specialty Services and Psychiatric Services have a $35 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a 20% coinsurance with a copay between $0 and $45. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional services like Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Some services, like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, and Support for Caregivers of Enrollees are not covered. Kidney Disease Education Services have a 20% coinsurance, and Other Preventive Services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $2,000 per year, while inner ear, outer ear, and over-the-ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Preferred (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam per year. The plan offers a combined maximum of $225 per year for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Preferred (PPO) plan covers a variety of dental services, including oral exams, dental x-rays, and other diagnostic and preventive services, with no copay. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a maximum plan benefit coverage of $1250 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Preferred (PPO) plan, with prior authorization required. 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, but require prior authorization. You will pay a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Preferred (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $15, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $275, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Preferred (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Preferred (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $158. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services", the Aetna Medicare Preferred (PPO) plan covers over-the-counter items with no copay and a maximum benefit coverage amount of $30 every three months. Other covered services include annual wellness exams and screening mammography with no copay, and gFOBT and FIT with no copay. Acupuncture, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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