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Aetna Medicare Gold (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Gold (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Gold (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Gold (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IN Northwest. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Gold (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 Gold (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 Gold (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.00. 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 Gold (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, you'll pay no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies or standard mail order. Other tiers have 22% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Gold (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, and outpatient services range from no copay to $325. Emergency services have a copay, while primary care visits have no copay. Preventive services, including an annual physical exam, are covered with no copay, and vision and dental services also have no copay for most services. Hearing exams have a copay, and prescription hearing aids are covered up to $1,000 per year. The plan also covers a variety of other services, such as home health, skilled nursing, and OTC items, with specific copays or coinsurance applying in some cases.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered by the Aetna Medicare Gold (PPO) plan. For inpatient acute and psychiatric care, you will pay a $325 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Aetna Medicare Gold (PPO) plan, with copays ranging from $0 to $325 depending on the service. Outpatient substance abuse services are also covered, with a $75 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) services and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Gold (PPO) plan, but requires prior authorization. You will have a $65 copay 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 $300 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, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Aetna Medicare Gold (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Gold (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, and physician specialist services with a $30 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services with a $60 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance with a copay between $0 and $75. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Gold (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services, such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. Some services are not covered, including In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids are covered up to $1,000 per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, 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 $30, and routine eye exams have no copay; eyewear, including contact lenses, eyeglass lenses and frames, and upgrades, also have no copay, with a combined maximum plan benefit coverage of $250 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Gold (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. Medicare Dental Services require prior authorization and have a $30 copay. The plan has a maximum benefit of $2,500 per year for both in-network and out-of-network services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered with prior authorization, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Gold (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 15%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment with a coinsurance and copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Gold (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $60, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $225, and Outpatient X-Ray Services have a $5 copay; Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Gold (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Gold (PPO) plan, but the specific sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for the covered services; however, the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Gold (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Gold (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $60 every three months. The plan also offers a meal benefit with no copay, along with other services such as annual wellness exams and screening mammography, and gFOBT, FIT, all with no copay. However, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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