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Aetna Medicare Advantra Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra 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 Advantra Premier (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Premier (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 2026.
It's important to know that Aetna Medicare Advantra 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 Advantra 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 Advantra Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $98.00. 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 $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:
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Drug Coverage
The Aetna Medicare Advantra Premier (PPO) prescription drug plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred retail pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options require copays ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. For brand-name and specialty medications, costs are structured as a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy types. Additionally, Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Premier (PPO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, while specialist visits range from no copay to a $25 copay. For acute inpatient hospital stays, members pay a $475 copay per stay with no coinsurance, and emergency room visits require a $130 copay which is waived if admitted. Ground ambulance services carry a $250 copay, while air ambulance and dialysis services require a 20% coinsurance. Routine vision and preventive dental care are covered with no copay and no coinsurance, with eyewear covered up to a $400 annual limit and comprehensive dental requiring 20% to 50% coinsurance. Hearing exams and prescription hearing aids are also covered with no copay, with aids capped at a $500 annual limit per ear. Additionally, members benefit from home health services and diagnostic lab tests with no copay, alongside a $45 quarterly over-the-counter allowance.
Inpatient Hospital See details
Aetna Medicare Advantra Premier (PPO) partially covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute care requires a $475 copay per stay with no copay for unlimited additional days, while psychiatric care requires a $350 daily copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
Aetna Medicare Advantra Premier (PPO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $300, observation services have a $300 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Aetna Medicare Advantra Premier (PPO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the service, you will pay either no copay or a $145 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Aetna Medicare Advantra Premier (PPO), as transportation services to plan-approved or any health-related locations are not covered. Medicare-covered ground ambulance services require a $250 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Aetna Medicare Advantra 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. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $250.
Primary Care See details
Aetna Medicare Advantra Premier (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $25 copay and no coinsurance. Other covered benefits include physical and occupational therapy for a $20 copay and no coinsurance, while chiropractic care is partially covered with a $15 copay and no coinsurance, excluding other chiropractic services.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Advantra Premier (PPO), with most covered benefits like annual physicals, fitness programs, and screenings requiring no copay and no coinsurance, while kidney disease education has no copay and 20% coinsurance. However, the plan does not cover 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, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, or counseling.
Hearing Services See details
Aetna Medicare Advantra Premier (PPO) offers hearing services with no coinsurance, including Medicare-covered exams for a $25 copay, alongside annual routine exams and fitting evaluations for no copay. Prescription hearing aids are partially covered with no copay up to a $500 annual maximum per ear, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Advantra Premier (PPO) with no deductible and no coinsurance. Eye exams carry a copay of $0 to $25 (including no copay for routine annual exams) up to a $50 yearly limit, while contact lenses and eyeglasses are covered with no copay up to a $400 annual maximum.
Dental Services See details
Aetna Medicare Advantra Premier (PPO) partially covers dental services, providing Medicare-covered dental with a $25 copay and no coinsurance, alongside preventive care like cleanings and exams for no copay and no coinsurance. Covered comprehensive services require no copay and 20% to 50% coinsurance up to a $1,250 annual limit; however, fluoride, other diagnostic, other preventive services, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Advantra Premier (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Premier (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Advantra Premier (PPO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment, diabetic supplies, and medical supplies range from no coinsurance to 20% coinsurance, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Premier (PPO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic tests, lab services, and diagnostic radiology have no copay and no coinsurance, while outpatient X-rays require a $15 copay and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Advantra Premier (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra Premier (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Premier (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring a daily copay of $10 for days 1 to 20 and $216 for days 21 to 100. Prior authorization is required and a prior three-day hospital stay is not needed, though additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Advantra Premier (PPO) partially covers other services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a $45 quarterly over-the-counter reimbursement, chronic illness meal benefits, annual wellness exams, screening mammography, and additional gFOBT and FIT screenings.
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