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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 MI Southwest and Southeast. 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 an enhanced alternative drug benefit. The plan has a $590 deductible. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay 22% or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Gold (PPO) plan offers a wide range of benefits with varying costs. For inpatient hospital stays, you'll pay a $325 copay for days 1-7 and no copay for the remaining days, while outpatient services and primary care visits have copays ranging from $0 to $75. Emergency services have a $125 copay, and ambulance services have a copay of $250 for ground transport and 20% coinsurance for air transport. Preventive services, including an annual physical exam, are available with no copay. Hearing exams have a $35 copay, and routine hearing exams are covered with no copay. Vision services include eye exams and eyewear with no copay, up to an annual combined maximum. Dental services, including oral exams, dental x-rays, and cleaning, are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $325 for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $75 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Gold (PPO) plan, but requires prior authorization. For this benefit, there is a $75 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Gold (PPO) plan. Ground ambulance services have a $250 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 under the Aetna Medicare Gold (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $35 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $250 copay, with a maximum benefit coverage of $100,000.
Primary Care See details
The Aetna Medicare Gold (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health and psychiatric services have a $60 copay for individual and group sessions, while other health care professional services have a copay between $0 and $35. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75, and opioid treatment program services have a $60 copay. 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. Additional preventive services are covered, including Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services has a 20% coinsurance.
Hearing Services See details
Aetna Medicare Gold (PPO) covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $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
The Aetna Medicare Gold (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with no copay, up to a combined maximum of $250 per year for both in-network and out-of-network services. Routine eye exams are limited to one per year with no copay, while other eye exam services and eyewear such as contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are also covered with coinsurance between 20% and 50%, while Orthodontic Services have a maximum benefit of $3500 per year. However, fluoride treatment, 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 Gold (PPO) plan, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Gold (PPO) plan, but prior authorization is required. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment and diabetic equipment, is covered. Durable medical equipment has a coinsurance between 0% and 15%, and prosthetics 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 under the Aetna Medicare Gold (PPO) plan, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay ranging from $0 to $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $290, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Gold (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 covered by the Aetna Medicare Gold (PPO) plan, but none of the specific services are covered. There is a copay for Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not provided.
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, there is no copay, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF 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 $75 every three months. Other covered services include a meal benefit with no copay, and annual wellness exams and screening mammography with no copay. Acupuncture, and several other services are not covered.
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