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Aetna Medicare Premier NJ South (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier NJ South (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 NJ South (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier NJ South (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern New Jersey. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier NJ South (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 NJ South (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 NJ South (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $66.00. 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 $450.00 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 $14000.00 (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 $14000.00 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 Premier NJ South (PPO) plan has a $450 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. Preferred Generic drugs have no copay at preferred pharmacies and preferred mail order, but a $12 copay at standard pharmacies and standard mail order. For other tiers, you'll pay coinsurance, ranging from 22% to 27% depending on the drug and pharmacy. 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 Premier NJ South (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays between $0 and $350. Emergency services, along with primary care, have copays. This plan includes coverage for preventive services, hearing and vision services, and dental services, often with no copays. The plan also covers home health services and skilled nursing facility stays, with varying cost-sharing amounts. Other benefits include coverage for ambulance, diagnostic, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $395 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric services have a $339 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but non-Medicare-covered stays and upgrades are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric services are also not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $350, observation services with a $395 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay for individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $60 copay for this benefit.
Ambulance and Transportation Services See details
For Aetna Medicare Premier NJ South (PPO), Ambulance Services are covered with a $300 copay for both ground and air ambulance services, and no coinsurance. Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Premier NJ South (PPO) plan. Emergency Services and Worldwide Emergency Coverage each have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Premier NJ South (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy with a $25 copay. Physician specialist services have a $35 copay, and mental health specialty services and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services. The additional preventive services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit have no copay. Kidney disease education services have 20% coinsurance.
Hearing Services See details
Hearing services include hearing exams with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered, with no copay. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Premier NJ South (PPO) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay and a combined maximum benefit of $150 every year. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, as well as oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. The plan also has a $1,000 annual maximum benefit for both in-network and out-of-network services, and does not cover maxillofacial prosthetics, implant services, or orthodontics.
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.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier NJ South (PPO) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 20%, and Diabetic Supplies have a coinsurance between 0% and 20%; other medical supplies have a coinsurance of 0% to 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests (with a $0-$35 copay), lab services (with no copay), and all radiological services. Additionally, diagnostic radiological services have a copay of at most $275, therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier NJ South (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier NJ South (PPO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, the plan does not cover the services themselves.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier NJ South (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes a meal benefit with no copay, and also covers other services including annual wellness exams and screening mammography, and gFOBT and FIT, all with no copay. Acupuncture, over-the-counter (OTC) items, Dual Eligible SNPs with Highly Integrated Services, 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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