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Aetna Medicare Advantra Signature Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Signature Giveback (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 Signature Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Advantra Signature Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in 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 Signature Giveback (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 Signature Giveback (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 Signature Giveback (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $44.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $950.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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 Signature Giveback (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling your prescriptions through a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 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 both require a 25% coinsurance across all pharmacy options. Please note that Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Advantra Signature Giveback (PPO) offers comprehensive medical coverage featuring no copay for primary care physician visits, while specialist visits require a $50 copay. Inpatient hospital stays require a daily copay for the first several days before transitioning to no copay, and outpatient hospital services range from no copay up to $388. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, providing routine dental, vision, and hearing exams with no copay or coinsurance. Members receive a $100 annual eyewear allowance, a $500 annual hearing aid benefit per ear, and a $30 quarterly allowance for over-the-counter items. Additionally, home health services and the first 20 days of skilled nursing facility care are covered with no copay.
Inpatient Hospital See details
Aetna Medicare Advantra Signature Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $388 daily copay for days 1-7 of acute stays (no copay for days 8 and beyond) and a $350 daily copay for days 1-5 of psychiatric stays (no copay for days 6-90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers outpatient services with no coinsurance, featuring a $0 to $388 copay for outpatient hospital services and a $388 copay per stay for observation services. Under this plan, there is no copay or coinsurance for ambulatory surgical center and blood services, while individual and group outpatient substance abuse sessions require a $45 copay.
Partial Hospitalization See details
Aetna Medicare Advantra Signature Giveback (PPO) covers partial hospitalization services with a copay of $60.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Advantra Signature Giveback (PPO), with ground ambulance services requiring a $300 copay and no coinsurance, and air ambulance services requiring 20% coinsurance and no copay, both subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services under the Aetna Medicare Advantra Signature Giveback (PPO) are covered with a $115 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays of $115 for emergency or urgent care and $300 for emergency transportation.
Primary Care See details
Aetna Medicare Advantra Signature Giveback (PPO) provides primary care physician visits with no copay and no coinsurance, while specialist visits require a $50 copay and no coinsurance. Physical, occupational, and speech therapies feature a $35 copay and no coinsurance, but chiropractic services are not covered in practice. Mental health, psychiatric, and podiatry services require copays ranging from $40 to $50 with no coinsurance.
Preventive Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers key preventive services like annual physicals and diabetes training with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered, as sub-services such as in-home safety assessments, weight management programs, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers Medicare-covered hearing exams for a $50 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay and no coinsurance, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Advantra Signature Giveback (PPO) vision services are covered with no coinsurance and no deductibles, featuring a $0 to $50 copay for eye exams and no copay for eyewear. The plan includes one annual routine eye exam up to a $50 maximum benefit and provides a $100 yearly combined allowance for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Advantra Signature Giveback (PPO), featuring no copay and no coinsurance for preventive care like cleanings and exams, and a $50 copay with no coinsurance for Medicare-covered dental. Covered comprehensive services require no copay and 20% to 50% coinsurance up to a $500 annual benefit limit, though other diagnostic services, fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra Signature Giveback (PPO) with no copay and no coinsurance, though prior authorization and step therapy are required. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Advantra Signature Giveback (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Advantra Signature Giveback (PPO) with no copay, though coinsurance ranges from no coinsurance up to 20% depending on the item. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, with some manufacturer limitations applying to diabetic equipment.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra Signature Giveback (PPO) covers diagnostic and radiological services with prior authorization required. Lab services and diagnostic radiological services have no copay and no coinsurance, diagnostic tests range from no copay to a $20 copay, outpatient X-rays require a $50 copay, and therapeutic radiology carries a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Advantra Signature Giveback (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no copay and no coinsurance under the Aetna Medicare Advantra Signature Giveback (PPO), but only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Advantra Signature Giveback (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Advantra Signature Giveback (PPO), which offers over-the-counter (OTC) items (up to $30 every three months), annual wellness exams, and additional colorectal screenings with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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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.
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