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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 Northeast and Southern. 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 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 $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 an "Enhanced Alternative" drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $5 copay at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Gold (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services may have copays depending on the service. Emergency, primary care, and preventive services often have no copay, but specialist visits have a $30 copay. The plan includes coverage for hearing, vision, and dental services. Hearing aids are covered up to a certain amount, while vision includes eye exams and eyewear with no copay. The plan also covers home health services with no copay and skilled nursing facilities with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric services, are covered under the Aetna Medicare Gold (PPO) plan. For Inpatient Hospital-Acute, you'll pay a $325 copay for days 1-7, and no copay for days 8-90; Inpatient Hospital Psychiatric services have the same cost structure.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Gold (PPO) plan, including all outpatient hospital services, ambulatory surgical center services, outpatient blood services, and outpatient substance abuse services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, and outpatient substance abuse individual and group sessions have a $75 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Gold (PPO) covers partial hospitalization with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Gold (PPO). Ground ambulance services have a $240 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 Gold (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $240 copay.
Primary Care See details
The Aetna Medicare Gold (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy with a $30 copay. Physician specialist services have a $30 copay, while mental health and psychiatric services have a $60 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75. Opioid treatment program services have a $60 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services include Health Education, Wigs for Hair Loss, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all of which have no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing services with the Aetna Medicare Gold (PPO) plan include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$30, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum of $250 per year.
Dental Services See details
The Aetna Medicare Gold (PPO) plan offers a dental services benefit with a $2,500 annual maximum. Medicare dental services have a $30 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 Gold (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 by the Aetna Medicare Gold (PPO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare Gold (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 10%, and Prosthetic Devices have a 50% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Gold (PPO). Diagnostic Procedures/Tests have a copay between $0 and $75, and Lab Services have no copay; Diagnostic Radiological Services have a copay of up to $220.00, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $20 copay.
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 by the Aetna Medicare Gold (PPO) plan, but specific services such as Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. The plan has a copay for covered services, but the exact amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Gold (PPO) with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF 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 benefit coverage amount of $60 every three months. The plan also covers meal benefits with no copay, as well as 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, 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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