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Aetna Medicare Freedom (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Freedom (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Freedom (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Freedom (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern MS. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Freedom (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 Freedom (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 Freedom (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 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 Freedom (PPO) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12.00 copay at standard pharmacies and standard mail order. For other tiers, you will pay coinsurance of 22% or 25%. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Freedom (PPO) plan provides comprehensive coverage with varying costs for different services. You'll find no copay for primary care visits, many preventive services, routine vision and dental, home health, and other services like OTC items. Hospital stays have copays, with outpatient services and emergency services also having copays. The plan includes coverage for hearing aids up to $500 per year, diagnostic and radiological services, and medical equipment with coinsurance requirements. Other benefits include ambulance services, mental health services, and cardiac rehabilitation services, with specific copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits for Aetna Medicare Freedom (PPO) include coverage for Inpatient Hospital-Acute, with a $335 copay for days 1-7 and no copay for days 8-90, and Inpatient Hospital Psychiatric, with a $407 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered by Aetna Medicare Freedom (PPO). Outpatient Hospital Services have a copay between $0 and $335, Observation Services have a $335 copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Freedom (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
The Aetna Medicare Freedom (PPO) plan covers ambulance services, with a $295 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Freedom (PPO) plan. Emergency Services and Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $295 copay; all of these services have no coinsurance. Urgently Needed Services has a $40 copay and no coinsurance.
Primary Care See details
The Aetna Medicare Freedom (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a copay between $0 and $45. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered under the Aetna Medicare Freedom (PPO) plan, with no copay for the annual physical exam. Additional preventive services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) have a $0 copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
The Aetna Medicare Freedom (PPO) plan covers hearing exams with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, with no copay for all types, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Aetna Medicare Freedom (PPO) plan covers vision services, including eye exams with a copay of $0-$45 and eyewear with no copay, up to a combined maximum of $160 per year. Routine eye exams are covered with no copay for one visit every year, and other eye exam services are covered with no copay.
Dental Services See details
The Aetna Medicare Freedom (PPO) plan covers dental services, including 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. This plan does not cover maxillofacial prosthetics, implant services, or orthodontics, and there is a $45 copay for Medicare dental services. There is a $1,000 maximum plan benefit coverage amount per year for both in-network and out-of-network services.
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 coinsurance between 0% and 20%. Prior authorization is required for all Home Infusion bundled Services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Freedom (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Freedom (PPO) plan, with a 16% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Supplies have a coinsurance between 0-20%, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for some services, and coinsurance for some services. Diagnostic Procedures/Tests have a copay between $0 and $95. Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300. Therapeutic Radiological Services have a coinsurance of 20% or more. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Freedom (PPO) plan with no copay and no coinsurance, but 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 Freedom (PPO) plan, but the specific services are not covered. The plan does not cover Medicare-covered 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Freedom (PPO) plan, with a prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Freedom (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, as well as other services like annual wellness exams and screening mammography, and gFOBT/FIT with no copay. Acupuncture, 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, 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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