A non-government entity
Aetna Medicare Platinum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Platinum (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Platinum (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Platinum (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Platinum (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 Platinum (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 Platinum (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $86.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4800.00 (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 $4800.00 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:
Sign up for Aetna Medicare Platinum (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Platinum (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you may pay a reduced premium.
Additional Benefits
The Aetna Medicare Platinum (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $100 copay per admission, with no copay for additional days. Outpatient services, including primary care, have no copay, while specialist visits have a $25 copay. Preventive services, hearing exams, vision services, and dental services have no copay. Emergency services have a $140 copay, and ambulance services have a $325 copay for ground transport. The plan also includes coverage for prescription hearing aids and offers a $90 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Platinum (PPO) plan. For Inpatient Hospital-Acute, there is a $100 copay per admission for a Medicare-covered stay, and additional days are unlimited with no copay. Inpatient Hospital Psychiatric has a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Platinum (PPO) plan, including Outpatient Hospital Services with a copay between $0 and $50, and Observation Services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Platinum (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Platinum (PPO) plan. Ground ambulance services have a $325 copay, while air ambulance services have a 20% 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 by the Aetna Medicare Platinum (PPO) plan. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $35 copay and no coinsurance, and Worldwide Emergency Services have a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $325 copay for Worldwide Emergency Transportation, with no coinsurance for all services.
Primary Care See details
The Aetna Medicare Platinum (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $25 copay, and physician specialist services have a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $25 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $35.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services and other services are covered with no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
The Aetna Medicare Platinum (PPO) plan covers hearing exams with no copay, as well as routine hearing exams and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids are covered up to $1250 per year, but 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, including eye exams and eyewear, are covered by the Aetna Medicare Platinum (PPO) plan. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $500 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Aetna Medicare Platinum (PPO) plan covers dental services with a $25 copay for Medicare dental services, and other dental services are covered with a maximum benefit of $2200 per year. 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 have no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Platinum (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 with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetic Devices with a 20% coinsurance. Diabetic Equipment is covered with a coinsurance between 0% and 20% for Diabetic Supplies, and no copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The Aetna Medicare Platinum (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with a copay up to $225, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Platinum (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 under the Aetna Medicare Platinum (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Platinum (PPO) plan with prior authorization required. You will have no copay for days 1-20, and a $50 copay for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Platinum (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit of $90 every three months. Other services like acupuncture, meal benefits, and several others are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved