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Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Signature (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wake and Durham Counties NC. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (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 $615.00 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 $7750.00 (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 $7750.00 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 Signature (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when utilizing a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose standard pharmacies or standard mail-order services, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For higher-tier medications, costs transition to coinsurance percentages across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs incur a 25% coinsurance. These percentage-based costs apply equally whether you use preferred or standard filling methods, helping you easily estimate your out-of-pocket expenses.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers robust coverage for essential medical needs, with a $10 copay for primary care visits and no copay to a $55 copay for specialists. If you are admitted to the hospital, you will pay a $382 daily copay for the first eight days of acute care and no copay for additional days. Emergency room visits carry a $130 copay, which is waived upon admission, while urgent care visits require a $50 copay. Routine services like annual physicals, eye exams, and dental cleanings are fully covered with no copay or coinsurance. Hearing care is also highly accessible, offering routine exams at no copay and a hearing aid allowance of up to $1,250 per ear. For other specialized needs, home health care and diagnostic lab services require no copay, while durable medical equipment and dialysis require up to 20% coinsurance.
Inpatient Hospital See details
Inpatient Hospital care is covered by Aetna Medicare Signature (PPO) with no coinsurance, though prior authorization is required. For acute stays, you pay a $382 daily copay for days 1 through 8 and no copay for days 9 and beyond, while psychiatric stays require a $292 daily copay for days 1 through 8 and no copay for days 9 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Signature (PPO) are covered with no coinsurance, including no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $382, observation services have a $382 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Aetna Medicare Signature (PPO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Aetna Medicare Signature (PPO) plan are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Signature (PPO) covers primary care physician visits for a $10 copay and specialist visits for no copay to a $55 copay, both with no coinsurance. Therapy, mental health, and psychiatric services require a $40 copay and no coinsurance, while telehealth services carry a 20% coinsurance with no copay to a $55 copay, and chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) covers key preventive services and annual physicals with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance with no copay. While supplemental benefits like fitness and health education are covered at no cost, this benefit is only partially covered as services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing exams with a $55 copay and no coinsurance for Medicare-covered services, while routine exams and fitting evaluations have no copay and no coinsurance. Hearing aids are partially covered with no copay or coinsurance up to a $1,250 annual maximum per ear, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductible and no coinsurance, offering no copay for routine eye exams and covered eyewear. Eye exams carry a copay of up to $55 with a $50 annual maximum, while eyewear features no copay with a combined annual limit of $100.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Signature (PPO), featuring Medicare-covered dental care for a $55 copay and no coinsurance, and routine exams, cleanings, and x-rays with no copay or coinsurance. However, fluoride, orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin has a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Signature (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers medical equipment—including durable medical equipment, prosthetics, and diabetic supplies—with no copays and coinsurance ranging from 0% to 20%. Prior authorization is required for these benefits, and diabetic supplies may be limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Signature (PPO) with prior authorization. Outpatient diagnostic tests require a $0 to $200 copay with no coinsurance, lab services have no copay and no coinsurance, and radiological services range from a $10 copay with coinsurance for X-rays to a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Signature (PPO) with no coinsurance, though some services are covered while standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Signature (PPO), which offers an annual wellness exam, screening mammography, and additional gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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