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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 Southeastern 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 $106.00. 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:
Sign up for Aetna Medicare Advantra Premier (PPO)
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Drug Coverage
The Aetna Medicare Advantra Premier (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-, two-, or three-month supplies when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, Tier 1 drugs carry a copay starting at $2.00, while Tier 2 drugs carry a copay starting at $12.00. For higher-tier medications, the plan transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options, while Tier 4 non-preferred drugs and Tier 5 specialty tier drugs require a 25% coinsurance. Specialty drugs are limited to a one-month supply, whereas Tier 3 and Tier 4 medications are available in up to three-month supplies.
Additional Benefits
Aetna Medicare Advantra Premier (PPO) offers robust medical coverage with no copay for primary care visits and low copays ranging from $0 to $35 for specialists. Emergency care is available with a $130 copay, while inpatient hospital stays require a $300 daily copay for the first seven days of acute care with no coinsurance. Outpatient services and diagnostic tests are also highly accessible, featuring no coinsurance and minimal to no copays for most procedures. The plan provides valuable everyday health benefits, including routine dental, vision, and hearing exams with no copays, alongside annual allowances for eyewear and hearing aids. Members also benefit from covered skilled nursing facility stays with no coinsurance and low daily copays, plus a $30 quarterly over-the-counter allowance. Preventive services, fitness benefits, and home health care are fully covered with no copays or coinsurance.
Inpatient Hospital See details
Aetna Medicare Advantra Premier (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $300 copay per day for days 1-7 of acute stays (no copay for days 8 and beyond) and a $350 copay per day for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Advantra Premier (PPO) covers outpatient services with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $300 copay per stay for observation services. There is no copay or coinsurance for ambulatory surgical center and blood services, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Advantra Premier (PPO) 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
Aetna Medicare Advantra Premier (PPO) covers ambulance services with prior authorization, requiring a $300 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Advantra Premier (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care is covered with a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Aetna Medicare Advantra Premier (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Physical, occupational, speech, and podiatry services carry a $35 copay with no coinsurance, while chiropractic services are only partially covered as routine and other chiropractic services are not covered. Mental health, psychiatric, and opioid treatment services have a $40 copay and no coinsurance, while telehealth is available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Advantra Premier (PPO) partially covers preventive services, offering annual physicals, health education, fitness benefits, and various screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Not covered under this benefit are in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling.
Hearing Services See details
Aetna Medicare Advantra Premier (PPO) provides partially covered hearing services, featuring Medicare-covered exams for a $35 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay or coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Advantra Premier (PPO) with no coinsurance and copays ranging from $0 to $35 for eye exams, which are subject to a $50 annual maximum. Eyewear, including contacts and eyeglasses, is also covered with no copayments or coinsurance up to a combined maximum of $275 every year.
Dental Services See details
Aetna Medicare Advantra Premier (PPO) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and preventive care like cleanings and exams with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $1,250 annual maximum, though 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 Advantra Premier (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and clinical drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Advantra Premier (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Advantra Premier (PPO) covers medical equipment with no copays, although prior authorization is required. Members will pay between no coinsurance and 20% coinsurance for durable medical equipment, medical supplies, and diabetic supplies, and a flat 20% coinsurance for prosthetics and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Advantra Premier (PPO) with no copay and no coinsurance for lab services, diagnostic tests, and diagnostic radiology. Outpatient X-rays require a $35 copay and coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and a copay, with prior authorization required for these services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Advantra Premier (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Advantra Premier (PPO) with no copay and no coinsurance, though only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra Premier (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Aetna Medicare Advantra Premier (PPO) provides partially covered other services with no copay and no coinsurance, including a chronic illness meal benefit, additional wellness screenings, and a $30 quarterly over-the-counter allowance. Acupuncture is not covered under this plan.
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Every year, Medicare evaluates plans based on a 5-star rating system.
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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