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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 WI 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. You must pay a $590 deductible before your drug coverage begins. In the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will pay no copay at preferred pharmacies or through preferred mail order, and a $12 copay at standard pharmacies or through standard mail order. The coinsurance for standard generic drugs, preferred brand drugs, and non-preferred drugs is 22% or 25% depending on the tier and pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your drugs.
Additional Benefits
The Aetna Medicare Gold (PPO) plan offers comprehensive coverage with varying costs for different services. This plan includes no copay for primary care visits, preventive services, and home health services. You can also expect no copay for dental exams, oral exams, dental x-rays, and cleaning, and eyewear. The plan has copays for inpatient hospital stays, outpatient services, and specialist visits, and coinsurance for air ambulance services and dialysis. Other services, like hearing exams and some outpatient services, have copays. The plan also includes coverage for hearing aids up to $1,000 per year, and a $90 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
The Aetna Medicare Gold (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $325 copay for days 1-7 and no copay for days 8-90. Inpatient hospital psychiatric services are also covered with the same cost-sharing structure, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, outpatient substance abuse services, and outpatient blood services, are covered by the Aetna Medicare Gold (PPO) plan. Outpatient Hospital Services have a copay of $0-$325, Observation Services have a copay of $325, Ambulatory Surgical Center (ASC) Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75.00.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Gold (PPO) plan, but requires prior authorization. You will have a $75 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Gold (PPO) plan. Ground ambulance services have a copay of $280, while air ambulance services have a 20% coinsurance, and 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $35 copay, and Worldwide Emergency Transportation has a $280 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Gold (PPO) plan covers primary care physician services with no copay, and covers chiropractic services with a $20 copay. Occupational therapy services have a $40 copay, while physician specialist services have a copay between $0 and $40. Mental health and psychiatric services, along with opioid treatment services, have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75.
Preventive Services See details
The Aetna Medicare Gold (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services such as Health Education, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Wigs for Hair Loss Related to Chemotherapy, Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Aetna Medicare Gold (PPO) covers hearing exams with a $40 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 with no copay, while inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Aetna Medicare Gold (PPO) covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Eyewear has a combined maximum benefit of $250 every year for both in and out-of-network services.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay. Orthodontic Services have a maximum benefit of $3500. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance between 20% and 50%, while Fluoride Treatment, 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, with prior authorization required. 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. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 15%. Prosthetics/Medical Supplies - Non-Medicare benefit, Prosthetic Devices, and Medical Supplies are covered with varying coinsurance amounts. Diabetic Equipment is covered, with a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a copay for Medicare-covered Diabetes Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Gold (PPO) plan, with all diagnostic services and radiological services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have 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. However, 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.
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.
Other Services See details
The Aetna Medicare Gold (PPO) plan covers over-the-counter (OTC) items with no copay and a maximum benefit of $90 every three months. Meal benefits, Other 1 (annual wellness exam and screening mammography), and Other 2 (gFOBT, FIT) are covered with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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