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Aetna Medicare FL Explorer Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare FL Explorer Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare FL Explorer Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare FL Explorer Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare FL Explorer Premier (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 FL Explorer Premier (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 FL Explorer Premier (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 $10100.00 (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 $10100.00 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 FL Explorer Premier (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at preferred pharmacies or through the mail. For standard generic drugs, you will pay 22% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare FL Explorer Premier (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can have copays up to $350. Emergency and urgent care services have copays, and primary care visits have a $5 copay. Preventive services like annual physical exams have no copay, and the plan also covers hearing and vision services with copays. Dental services are covered up to a $1,000 annual maximum, and home health services have no copay. Diagnostic and radiological services have copays or coinsurance, and skilled nursing facility stays have a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $286 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services for Aetna Medicare FL Explorer Premier (PPO) include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $60 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare FL Explorer Premier (PPO) plan with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $290 copay, and air ambulance services have 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 under the Aetna Medicare FL Explorer Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $290 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare FL Explorer Premier (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, and occupational therapy services with a $45 copay. It also covers physician specialist services with a $50 copay, mental health specialty services with a $60 copay, other health care professional services with a $0-$50 copay, and psychiatric services with a $60 copay. Physical therapy and speech-language pathology services have a $65 copay, and additional telehealth benefits have a 20% coinsurance and a $0-$65 copay. The plan also covers opioid treatment program services with a $60 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services that may have a copay, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit. Kidney Disease Education Services have a 20% coinsurance, and other services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $50 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay of $0-$50, and routine eye exams and other eye exam services have no copay. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, and there is a combined maximum plan benefit of $170 per year for all eyewear.
Dental Services See details
Dental services are covered, with a $1,000 annual maximum. Medicare dental services have a $50 copay, while 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare FL Explorer Premier (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 25% with no copay, while Diabetic Supplies have a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and a copay for Medicare-covered diagnostic and therapeutic radiological services. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Therapeutic Radiological Services have at most 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare FL Explorer Premier (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 FL Explorer Premier (PPO) plan. Although the plan covers the benefit, it does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare FL Explorer Premier (PPO) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Aetna Medicare FL Explorer Premier (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay, and offers a maximum benefit coverage amount of $30 every three months. Other services such as acupuncture, meal benefits, and several others are not covered.
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