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Aetna Medicare Premier Plus NJ North (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus NJ North (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 North (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus NJ North (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern 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 North (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 North (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 North (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. 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 $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 $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 North (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after the deductible, you will pay a $0 copay for preferred generic drugs at preferred and mail order pharmacies, and $12.00 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance depending on the tier. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Premier Plus NJ North (PPO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient hospital stays with copays, outpatient services, and emergency services with copays. You can also expect no copays for primary care visits, preventive services, routine hearing exams, and many vision and dental services. This plan also covers services like ambulance, home health, and skilled nursing facilities, though some require copays or coinsurance. There are also copays for hearing aids, and diagnostic and radiological services. Be aware that some services, such as cardiac rehabilitation and certain dental procedures, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $360 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $339 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Premier Plus NJ North (PPO), including outpatient hospital services with a copay between $0 and $375, observation services with a $360 copay, ambulatory surgical center services with no copay, individual and group sessions for outpatient substance abuse with a $40 copay, and outpatient blood services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus NJ North (PPO) plan and requires prior authorization. For this benefit, you will have a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premier Plus NJ North (PPO) plan, 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 North (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Premier Plus NJ North (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (routine care not covered), occupational therapy services with a $30 copay, physician specialist services with a $35 copay, mental health and psychiatric individual and group sessions with a $40 copay, and physical therapy and speech-language pathology services with a $25 copay. The plan also covers other health care professionals with a copay between $0-$35, additional telehealth benefits with a 20% coinsurance and a $0-$45 copay, and opioid treatment program services with a $40 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, additional preventive services with varying copays, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney disease education services have a 20% coinsurance. Some services, such as in-home safety assessments, personal emergency response systems, and others, are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $35 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a maximum copay of $1700. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams have no copay, and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $150 per year.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, and prophylaxis (cleaning) with no copay, but fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, orthodontics, and oral and maxillofacial surgery are not covered. Medicare dental services require prior authorization and have a $35 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with 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 under the Aetna Medicare Premier Plus NJ North (PPO) plan. Prior authorization is required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, with Durable Medical Equipment (DME) subject to a 0% to 20% coinsurance, and Prosthetic Devices subject to 20% coinsurance. Diabetic Supplies have a coinsurance of 0% to 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services are covered. Diagnostic Procedures/Tests have a copay between $0 and $35, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $275, Therapeutic Radiological Services have a coinsurance of at least 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 Plus NJ North (PPO) plan with no copay and no coinsurance. However, 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 North (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Plus NJ North (PPO) plan, but prior authorization is required. There is no 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 are not covered.
Other Services See details
Other services include a meal benefit with no copay, and also cover annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, over-the-counter items, 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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