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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 North FL, Central 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when utilizing a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge copays starting at $2 for Tier 1 drugs and $12 for Tier 2 drugs. For higher-tier medications, costs are based on coinsurance regardless of which pharmacy or mail-order option you choose. You will pay a 24% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs as well as Tier 5 specialty drugs.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive medical coverage with no copays for primary care visits, home health services, and diagnostic lab work or X-rays. For inpatient hospital stays, members pay no coinsurance, though acute stays require a $350 daily copay for the first seven days. Emergency care is accessible with a $130 copay that is waived if admitted, alongside worldwide emergency coverage up to a $250,000 limit. This plan also features robust supplemental benefits, including preventive and comprehensive dental care with a $1,500 annual maximum and no copays. Routine vision and hearing exams are available with no copays, and prescription hearing aids feature copayments starting at $0. Additionally, members receive up to $45 every three months for over-the-counter wellness items with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Premier (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays and a $334 daily copay for days 1 to 7 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and 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, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a $0 to $350 copay, observation services have a $350 copay per stay, and outpatient substance abuse services carry a $25 to $30 copay with no coinsurance.
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 to access these benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Premier (PPO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $275 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
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 services are covered with no coinsurance up to a $250,000 benefit limit, with copays of $130 for emergency or urgent care and $275 for emergency transportation.
Primary Care See details
Aetna Medicare Premier (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Therapy services cost a $40 copay with no coinsurance, mental health sessions range from $25 to $30 with no coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Premier (PPO) offers partially covered preventive services, with most covered benefits like annual physicals and screenings requiring no copay and no coinsurance, except for kidney disease education which has a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, personal emergency response systems, 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, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Premier (PPO) offers hearing services with no deductible and no coinsurance, featuring a $50 copay for Medicare-covered exams and no copay for annual routine exams and fitting evaluations. Prescription hearing aids are covered with copays ranging from $0 to $1,700 with no coinsurance, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Premier (PPO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year with a $50 maximum annual benefit. The plan also features a $200 annual combined maximum benefit for eyewear, including contacts and eyeglasses, with no copay or coinsurance.
Dental Services See details
Aetna Medicare Premier (PPO) provides partially covered dental services with a combined in- and out-of-network annual maximum of $1,500. Medicare-covered dental services require a $50 copay and no coinsurance, while other covered preventive and comprehensive services are available with no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Premier (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this benefit, Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by the Aetna Medicare Premier (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Aetna Medicare Premier (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and prior authorization required. Coinsurance ranges from 0% to 20% depending on the specific item, though diabetic therapeutic shoes and inserts are covered with no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Premier (PPO), offering lab services and outpatient X-rays with no copays. Diagnostic procedures and tests range from a $0 to $100 copay with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Premier (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Premier (PPO) with no copayment and no coinsurance. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility services are covered by Aetna Medicare Premier (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Premier (PPO), which excludes acupuncture and meal benefits. Covered benefits include annual wellness exams, screening mammographies, additional gFOBT and FIT, and up to $45 every three months for over-the-counter items via reimbursement, all of which feature no copay and no coinsurance.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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