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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.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Select Central and Southwest Virginia counties. 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 $100.00. 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 has a $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 Premier (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs depending on the supply duration. Brand-name and specialty medications are covered under a coinsurance model rather than flat copays. You will pay 24% coinsurance for Tier 3 preferred brand drugs and 25% coinsurance for Tier 4 non-preferred drugs across all pharmacy and mail-order options. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Premier (PPO) plan provides robust medical coverage featuring no copays and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits carry a copay of up to $50, and emergency room care requires a $130 copay which is waived upon hospital admission. For inpatient hospital stays, members pay a daily copay of $382 for the first eight days of acute care, followed by no copay for days 9 through 90. Essential routine services like dental cleanings, vision exams, and hearing evaluations are covered with no copays, plus a $200 annual allowance for eyewear and up to $2,000 per ear for prescription hearing aids. The plan also features a $30 quarterly over-the-counter item allowance and no copays for diagnostic lab tests or home infusion services. While many services have no coinsurance, some benefits like dialysis and specific medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $382 for days 1 to 8 of acute stays and $292 for days 1 to 8 of psychiatric stays, followed by no copay for days 9 to 90. Unlimited additional acute days are covered at no cost, though additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Premier (PPO) with no coinsurance, featuring 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, with prior authorization required for several of these services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Premier (PPO) with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Premier (PPO) covers ambulance services with prior authorization, requiring a $275 copay and no coinsurance for ground services, and a 20% coinsurance with no copay for air services. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $275 copay and no coinsurance, up to a maximum plan benefit of $250,000.
Primary Care See details
Primary care benefits under the Aetna Medicare Premier (PPO) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Physical, occupational, and speech therapies carry a $30 copay with no coinsurance, while chiropractic and podiatry services are not covered. Mental health, psychiatric, and opioid treatment services require a $45 copay with no coinsurance, and telehealth services are available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Premier (PPO), offering no copay and no coinsurance for annual physicals, health education, fitness benefits, smoking cessation, and select screenings, while kidney disease education requires a 20% coinsurance and no copay. Wigs for chemotherapy-related hair loss are covered up to $400 annually with no copay and no coinsurance. Sub-services not covered include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Premier (PPO), offering Medicare-covered exams for a $50 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $2,000 per ear annually with no copay or coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no deductibles and no coinsurance, offering annual routine eye exams with a copay ranging from $0 to $50 up to a $50 yearly maximum. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a combined maximum plan benefit of $200 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Premier (PPO), featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive services like cleanings and exams. Covered comprehensive services require no copay with 20% to 50% coinsurance up to a $1,500 annual maximum, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services 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 and step therapy may be required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy and radiation drugs require a 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Premier (PPO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for all covered items. Depending on the specific equipment, coinsurance costs range from no coinsurance up to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Premier (PPO) plan, with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic procedures range from no copay to a $100 copay with no coinsurance, and radiological services vary from no copay for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Aetna Medicare Premier (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Premier (PPO) plan because all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered. Although the plan lists no coinsurance, these individual services require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $190 daily copayment for days 21 through 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not required, additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Premier (PPO) with no copay and no coinsurance for covered benefits, which include a chronic illness meal benefit, annual wellness exams, mammography and colorectal screenings, and a $30 quarterly over-the-counter item allowance. Acupuncture and certain other services are not covered under this plan.
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