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Aetna Medicare Advantra Premier Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Premier Plus (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Premier Plus (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Premier Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Pennsylvania. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Premier Plus (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 Advantra Premier Plus (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 Advantra Premier Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $72.00. 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 $9550.00 (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 $9550.00 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:
Sign up for Aetna Medicare Advantra Premier Plus (PPO)
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Drug Coverage
The Aetna Medicare Advantra Premier Plus (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Advantra Premier Plus (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copays for many services, such as primary care, preventive services, dental services, and home health services. You'll also find coverage for a variety of other services, including inpatient and outpatient services, emergency services, vision and hearing services, and more.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute, with a $400 copay per stay for a Medicare-covered stay, and Inpatient Hospital Psychiatric, with a $350 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Aetna Medicare Advantra Premier Plus (PPO) plan covers outpatient services, with no copay for outpatient hospital services, ambulatory surgical center services, and outpatient blood services. Individual and group sessions for outpatient substance abuse have a $40 copay, and observation services have a $300 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Premier Plus (PPO) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Premier Plus (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. 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 Advantra Premier Plus (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency and Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Advantra Premier Plus (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $20 copay. Physician specialist services have a copay between $0 and $25. Mental health specialty services, psychiatric services, and opioid treatment services have a $40 copay for individual or group sessions. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $500 per ear, per year, with no copay for prescription hearing aids of all types.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$25, and routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, frames, and upgrades, has no copay, and a combined maximum of $500 per year applies to all eyewear.
Dental Services See details
Dental services include a $25 copay for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. This plan has a maximum benefit coverage of $2250 per year for both in-network and out-of-network services, and Orthodontics and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Premier Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Advantra Premier Plus (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with no copay and 0% to 20% coinsurance, and Prosthetics/Medical Supplies, with no copay and coinsurance for Medicare-covered items. Diabetic Equipment is covered, including Diabetic Supplies with 0% to 20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, and Lab Services with no copay. Radiological Services include Diagnostic Radiological Services with a maximum copay of $225, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $15 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Premier Plus (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Advantra Premier Plus (PPO), but the plan does not cover any specific services. There is a copay for covered services, but no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Premier Plus (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Advantra Premier Plus (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. This plan offers no copay for Over-the-Counter (OTC) Items, Meal Benefit, Other 1, and Other 2.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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