A non-government entity
Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern Maine. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Premier (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 Premier (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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $84.00. 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 $500.00 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 $9500.00 (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 $9500.00 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 Premier (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Premier (PPO) plan features an annual prescription drug deductible of $500. Under this plan, you can save on medication costs with no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply length. For higher-tier medications, cost-sharing transitions to a percentage of the drug's cost across all pharmacy and mail-order options. You will pay a 22% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred) drugs. Tier 5 (Specialty) drugs require a 27% coinsurance for a one-month supply, regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
Aetna Medicare Premier (PPO) offers robust medical coverage with no copay for primary care visits, home health services, and annual physical exams. Specialist visits range from no copay up to $40, while inpatient hospital stays require a daily copay for the first seven days with no coinsurance. Emergency care is available with a $130 copay, which is waived upon admission, and urgent care visits require a $40 copay. The plan also features strong supplemental benefits, including routine dental, vision, and hearing exams with no copay and no coinsurance. Vision eyewear is covered up to a $200 annual maximum, while preventive and comprehensive dental services have no copay up to a $1,000 yearly limit. Additionally, members benefit from a $30 quarterly over-the-counter allowance and no copays for home infusion services and durable medical equipment.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring prior authorization and a daily copay of $395 for days 1 to 7 of acute stays and $275 for days 1 to 7 of psychiatric stays, with no copay for subsequent days. Additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
Aetna Medicare Premier (PPO) offers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $335 and observation services with a $250 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Premier (PPO), which does not cover transportation services to health-related locations. Covered ground ambulance services require a $295.00 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay, and both require prior authorization.
Emergency Services See details
Emergency services are covered by Aetna Medicare Premier (PPO) with a $130 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services have a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $295.
Primary Care See details
Primary care benefits under Aetna Medicare Premier (PPO) feature no copay and no coinsurance for primary care visits, and no copay to a $40 copay with no coinsurance for specialists. Therapy services require a $30 copay with no coinsurance, while podiatry is not covered and chiropractic services are partially covered, with routine and other chiropractic services excluded.
Preventive Services See details
Aetna Medicare Premier (PPO) partially covers preventive services, offering no copay and no coinsurance for annual physical exams, health education, and various screenings, though kidney disease education requires a 20% coinsurance with no copay. Several supplemental preventive services are not covered under this plan, including in-home safety assessments, personal emergency response systems, weight management programs, and nutritional benefits.
Hearing Services See details
Aetna Medicare Premier (PPO) provides partially covered hearing services with no coinsurance, offering annual routine hearing exams and fitting evaluations with no copay, while Medicare-covered exams require a $40 copay. Up to two prescription hearing aids are covered per year with a copay between $0 and $1,700 and no coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Premier (PPO) with no coinsurance, offering routine and diabetic eye exams with no copay and Medicare-covered exams with a copay of up to $40. Eyewear is also covered with no copay and no coinsurance up to a $200 annual combined maximum for contacts, lenses, and frames.
Dental Services See details
Dental Services are partially covered under the Aetna Medicare Premier (PPO) plan, which features a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive services up to a $1,000 annual limit. While many services like exams, cleanings, and x-rays are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Premier (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment with no copays, though prior authorization is required for most items. Durable medical equipment and medical supplies feature no copay and range from no coinsurance to 25% coinsurance, while prosthetic devices carry 20% coinsurance and manufacturer-limited diabetic supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Premier (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay of $0 to $40, while lab services and outpatient X-rays require no copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Premier (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 under the Aetna Medicare Premier (PPO) plan with no coinsurance. Covered services require a copay, which is $20 for cardiac and intensive cardiac rehabilitation, $15 for pulmonary rehabilitation, and $25 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $214 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Premier (PPO) with no copay and no coinsurance for wellness exams, chronic illness meals, and a $30 quarterly over-the-counter item allowance. Acupuncture is not covered under these benefits.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved