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Aetna Medicare Premier Plus NJ South (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus 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 Plus NJ South (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus 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 Plus 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 Plus 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 Plus NJ South (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 $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 Plus NJ South (PPO) plan has an enhanced alternative drug benefit. The plan has a $450 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for preferred generic drugs, you will have no copay at a preferred pharmacy or preferred mail order, and a $12 copay at a standard pharmacy or standard mail order. After your total drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus NJ South (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. You'll find no copays for many preventive services, such as annual exams and screenings, along with coverage for hearing and vision services. Additionally, the plan includes coverage for home health services, skilled nursing facilities, and medical equipment with no copays for many services. This plan offers additional benefits such as coverage for ambulance services, emergency services, and primary care visits with copays. Diagnostic and radiological services are covered with a mix of copays and coinsurance, while services like dental, hearing, and vision have their own specific copay structures. Keep in mind that some services, like certain dental procedures and cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric care. For Inpatient Hospital-Acute, you will pay a $380 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay 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, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $380 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus NJ South (PPO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $300 copay for both Ground and Air Ambulance Services and no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Premier Plus NJ South (PPO) plan. Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier Plus NJ South (PPO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $15 copay, but routine care is not covered. Occupational therapy services have a $30 copay. Specialist visits have a $35 copay. Mental health and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, along with additional preventive services. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay; in addition, this plan covers wigs for hair loss related to chemotherapy with no copay and a maximum plan benefit coverage amount of $400. This plan also covers kidney disease education services with 20% coinsurance. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, are covered with no copay.
Hearing Services See details
The Aetna Medicare Premier Plus NJ South (PPO) plan covers hearing exams with a $35 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, up to 1 visit per year for each. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types, but not for inner ear, outer ear, or over the ear hearing aids. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$35, while routine eye exams and other eye exam services have no copay; eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, has no copay.
Dental Services See details
The Aetna Medicare Premier Plus NJ South (PPO) plan covers dental services, including oral exams, dental x-rays, and prophylaxis (cleaning). Oral exams and dental x-rays have no copay, while Medicare dental services have a $35 copay. Fluoride treatments, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. 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 by the Aetna Medicare Premier Plus NJ South (PPO) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Premier Plus NJ South (PPO) plan. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures, and lab services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, while Outpatient X-Ray Services have a copay of $35. Therapeutic Radiological Services have a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus 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 Plus NJ South (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Premier Plus NJ South (PPO) with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Premier Plus NJ South (PPO) plan covers meal benefits with no copay, and also covers other services, including annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, over-the-counter items, and several additional services are not covered.
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