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Aetna Medicare Explorer (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Explorer (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern New Hampshire. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Explorer (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 Explorer (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 Explorer (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $47.00. 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 $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 $10000.00 (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 $10000.00 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 Explorer (PPO) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, you'll pay no copay for preferred generic drugs at preferred and mail-order pharmacies, and a $12 copay at standard pharmacies. You will pay 24% coinsurance for standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. After your total yearly drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Explorer (PPO) plan covers a wide range of services, including inpatient and outpatient hospital care, with varying copays. Emergency services and primary care visits have copays, while many preventive services have no copay. Vision and hearing services are included, with copays for exams, and coverage for eyewear and hearing aids. This plan also offers coverage for dental services, home health, medical equipment, and diagnostic services, with a mix of copays and coinsurance. Additional benefits include coverage for ambulance services, skilled nursing facilities, and cardiac rehabilitation, with some services requiring prior authorization. The plan also covers over-the-counter items and meal benefits, but some services like podiatry and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Acute and Psychiatric care, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $395 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $275 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Explorer (PPO) plan, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $335, observation services have a $295 copay, ASC services have no copay, individual and group sessions for outpatient substance abuse have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Explorer (PPO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance; transportation services to plan-approved and any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Explorer (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $295 copay.
Primary Care See details
Under the Aetna Medicare Explorer (PPO) plan, primary care physician services have a $5 copay, chiropractic services have a $15 copay, and occupational therapy services have a $45 copay. Physician specialist services have a copay between $0 and $45, while mental health and psychiatric services, including individual and group sessions, have a $45 copay. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Other health care professional services have a copay between $0 and $45, and opioid treatment program services have a $45 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Explorer (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a $0 copay, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Wigs for hair loss related to chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit are also covered with no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and 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 $40, and routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum benefit of $150 every year.
Dental Services See details
The Aetna Medicare Explorer (PPO) plan covers Medicare Dental Services with a $40 copay, and also covers Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) with no copay, but does not cover Fluoride Treatment, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, or Orthodontics. Oral exams are limited to 4 per year, and dental x-rays and cleanings are limited to 1 and 2 per year, respectively.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Explorer (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while 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 Explorer (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while 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 with a copay between $0 and $40, lab services with no copay, and outpatient X-ray services with a $5 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services have a maximum copay of $175.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Explorer (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 covered by the Aetna Medicare Explorer (PPO) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. The copay for these services is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Explorer (PPO) plan with prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay; additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Explorer (PPO) plan covers over-the-counter items and meal benefits with no copay. Acupuncture, 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, 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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