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Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Premier (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Premier (PPO) is a PPO plan offered by Aetna Life Insurance Company available for the 2026 plan year to people living in Central. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $53.00. 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 $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $10100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Premier (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply length. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. You will pay a 24% coinsurance for Tier 3 preferred brand drugs across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, with specialty medications limited to a one-month supply.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers robust coverage with no copays or coinsurance for primary care visits, preventive services, home health care, and routine vision exams. For specialized medical needs, members pay a $40 copay for specialist visits, while inpatient hospital stays require a daily copay of $395 for the first seven days with no coinsurance. Emergency room visits carry a $130 copay, and skilled nursing facility stays are covered with no copay for the first 20 days. Ancillary benefits include comprehensive dental care and annual hearing exams with no copay, alongside prescription hearing aid coverage with copays up to $1,700. Vision benefits also feature no copays or deductibles, offering a $200 annual allowance for glasses and contacts. Additionally, diagnostic lab work and outpatient X-rays are available with no copays, helping members manage their health with minimal out-of-pocket expenses.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Premier (PPO) with no coinsurance, requiring prior authorization and a daily copay of $395 for days 1 through 7 of acute stays and $334 for days 1 through 7 of psychiatric stays. There is no copay for additional days of acute stays or days 8 through 90 of psychiatric stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also feature no copay. Outpatient hospital services have a copay of up to $395 with no coinsurance, while observation services require a $395 copay per stay and outpatient substance abuse sessions require a $60 copay, both with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Premier (PPO) plan with a copay of either $105.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ground ambulance services with a $290 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copayment, with prior authorization required. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency services are also covered up to a $250,000 maximum with no coinsurance, requiring a $130 copay for emergency or urgent care and a $290 copay for emergency transportation.
Primary Care See details
Aetna Medicare Premier (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $40 copay and no coinsurance. Mental health, psychiatric, and therapy services require copays ranging from $45 to $65 with no coinsurance, while telehealth services carry a $0 to $65 copay and 20% coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Premier (PPO), featuring no copays and no coinsurance for annual physical exams, glaucoma screenings, diabetes training, and fitness benefits. While kidney disease education is covered with a 20% coinsurance and no copay, several services such as in-home safety assessments, weight management programs, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Premier (PPO), featuring Medicare-covered exams for a $40 copay and no coinsurance, plus one routine exam and fitting evaluation per year with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay between $0 and $1,700, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Premier (PPO) with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This benefit includes one routine eye exam per year up to a $50 maximum, as well as a $200 annual combined allowance for contacts, eyeglass lenses, frames, and upgrades.
Dental Services See details
Dental services under the Aetna Medicare Premier (PPO) are partially covered, requiring a $40 copay and no coinsurance for Medicare-covered dental. Other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Premier (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%.
Dialysis Services See details
Aetna Medicare Premier (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays, though prior authorization is required. Coinsurance ranges from no coinsurance to 20% depending on the item, with prosthetic devices requiring 20% coinsurance and diabetic therapeutic shoes or inserts having no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Premier (PPO) plan with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic tests and procedures have no coinsurance and a copay of $0 to $75, while diagnostic radiological services have copays starting at $0 and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Premier (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Premier (PPO) plan, as all associated sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Premier (PPO) partially covers other services, offering select over-the-counter (OTC) items up to $45 every three months, annual wellness exams, and additional colorectal screenings with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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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