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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 South FL, Treasure Coast FL. 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 $74.00. 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 $10100.00 (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 $10100.00 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 generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, Tier 1 drugs have a copay between $2 and $6, while Tier 2 drugs have a copay between $12 and $36. For higher-tier medications, cost-sharing transitions to coinsurance 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 carry a 25% coinsurance. Tier 5 specialty drugs are limited to a one-month supply, whereas Tier 3 and Tier 4 medications are available in one, two, or three-month supplies.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive coverage for core medical services, featuring no copay for primary care doctor visits, home health services, and the first 20 days of a skilled nursing facility stay. Specialist office visits require a $45 copay, emergency room care has a $130 copay, and inpatient hospital stays require a $395 daily copay for the first six days. Outpatient hospital services, diagnostic tests, and laboratory services are also covered with no coinsurance and low-to-no copays. For supplemental health benefits, members enjoy no copay and no coinsurance for routine vision exams, preventive dental care, and routine hearing tests, up to specified annual allowance limits. Prescription hearing aids are covered with copays ranging from no copay up to $1,700, while durable medical equipment and dialysis services generally require up to 20% coinsurance. Additionally, Medicare Part B insulin is capped at a $35 copay, while other Part B chemotherapy and radiation treatments carry up to 20% coinsurance with no copay.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 6 of acute stays (with no copay for additional days) and a $390 daily copay for days 1 through 6 of psychiatric stays (with no copay for days 7 through 90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Premier (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $0 to $395 and observation services at a $395 copay per stay. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services have no coinsurance and copays of $25 for group sessions and $30 for individual sessions.
Partial Hospitalization See details
Aetna Medicare Premier (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under Aetna Medicare Premier (PPO) are covered with a $275 copay for ground transportation and a 20% coinsurance for air transportation, with prior authorization required for both services. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Premier (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are covered with a $130 copay, while worldwide emergency transportation has a $275 copay, all with no coinsurance up to a $250,000 maximum benefit.
Primary Care See details
Primary care benefits under the Aetna Medicare Premier (PPO) feature primary care physician visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Chiropractic services are only partially covered, with routine and other chiropractic services not covered, while podiatry services are also not covered. Therapy services, including physical and occupational therapy, are covered with a $40 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Premier (PPO) plan, with most covered services, including annual physicals, requiring no copay and no coinsurance, while kidney disease education has no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered under the Aetna Medicare Premier (PPO) plan, which offers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $0 to $1,700, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Premier (PPO) with no copay and no coinsurance for all covered eye exams and eyewear. The plan features a $50 annual maximum for eye exams, which includes one routine exam per year, and a $200 yearly combined maximum allowance for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Premier (PPO), which features a $1,500 annual maximum benefit for both in-network and out-of-network care. Most covered preventive and comprehensive services have no copay and no coinsurance, while Medicare-covered dental services require a $45 copay and no coinsurance, and maxillofacial prosthetics, implant services, and orthodontics 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 is required. Medicare Part B chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
The Aetna Medicare Premier (PPO) plan covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and prior authorization required. Coinsurance ranges from no coinsurance to 20% for most equipment and supplies, while prosthetic devices carry a 20% coinsurance and diabetic therapeutic shoes or inserts have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under Aetna Medicare Premier (PPO) are covered with no coinsurance and no copay for lab services, though diagnostic procedures and tests carry a copay of $0 to $100. Outpatient X-rays and diagnostic radiological services feature no copay, while therapeutic radiological services require a 20% coinsurance.
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, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage. Consequently, there are no copays or coinsurance associated with these services since they are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Premier (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Premier (PPO) provides partial coverage for other services, offering select benefits like over-the-counter (OTC) items, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs are not covered under this benefit.
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