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Aetna Medicare Primary (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Primary (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Primary (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Primary (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Memphis Tennessee 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 Primary (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 Primary (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 Primary (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7750.00 (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 $7750.00 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 Primary (PPO)
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Drug Coverage
The Aetna Medicare Primary (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies and a $12 copay at standard pharmacies. You will pay coinsurance for other tiers of drugs. 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 Primary (PPO) plan offers a range of benefits, including inpatient hospital care with a copay, outpatient services, and emergency services. Primary care visits have no copay, and the plan covers preventive services like eye exams, hearing exams, and dental services with various copays. Additional benefits include coverage for hearing aids, eyewear, and a maximum of $400 for wigs related to chemotherapy. The plan also covers home health services, medical equipment, and diagnostic services with varying copays and coinsurance, along with an OTC allowance of $45 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Primary (PPO) plan, with a copay of $299 per day for days 1-10 of inpatient hospital-acute care, and no copay for days 11-90. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $286 per day for days 1-8, and no copay for days 9-90. Non-Medicare-covered stays and upgrades for both inpatient hospital acute and inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $299, Observation Services have a $299 copay, Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Primary (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Primary (PPO). Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $275 copay; Urgently Needed Services has a $50 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay for routine care, while Occupational Therapy Services have a $40 copay, and no coinsurance. Physician Specialist Services have a copay between $10 and $50, and Mental Health and Psychiatric services each have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay with no coinsurance, and Additional Telehealth Benefits have a 20% coinsurance with a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams, additional preventive services (with copays for health education, additional sessions of smoking and tobacco cessation counseling, fitness benefit, and remote access technologies), kidney disease education services (with 20% coinsurance), and other preventive services (with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit). The plan also covers wigs for hair loss related to chemotherapy with no copay and a maximum plan benefit coverage amount of $400.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $50 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1250 per ear, per year with no copay, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay between $0 and $50, and eyewear with no copay. Routine eye exams are covered with no copay, and other eye exam services are covered with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay. The plan offers a combined maximum of $110 for eyewear every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $50 copay, and other dental services with a $1,050 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Primary (PPO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Primary (PPO) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 0-20% coinsurance. Diabetic Equipment is also covered, with no copay for Diabetic Therapeutic Shoes/Inserts and 0-20% coinsurance for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Primary (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $14 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Primary (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Primary (PPO) plan. While the plan covers some Cardiac and Pulmonary Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Primary (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Primary (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $45 every three months. Other services like acupuncture, and services for Dual Eligible SNPs, are not covered. The plan also covers meal benefits with no copay, and other services like annual wellness exams.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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