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Aetna Medicare Signature Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Signature Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature Giveback (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 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 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 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 $30.00. You must continue to pay paying your reduced 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 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 using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail-order services, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. Higher tier medications require coinsurance rather than flat copayments regardless of the pharmacy you choose. You will pay 24% coinsurance for Tier 3 preferred brand drugs and 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also carry a 25% coinsurance, which is restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Signature Giveback (PPO) plan offers robust coverage for core medical services with many benefits featuring no coinsurance. You will pay no copay for primary care visits, while specialist visits require a $50 copay and inpatient hospital stays carry a $350 daily copay for the first seven days of acute stays. Emergency care is covered with a $130 copay, and outpatient services feature no copay for ambulatory surgical centers. Routine preventive services, annual physicals, and diagnostic lab tests are fully covered with no copay and no coinsurance. Dental, vision, and hearing benefits are also included, featuring no copay for routine exams and cleanings, alongside allowance-based coverage for prescription hearing aids and eyewear. Other essential services like home health care and cardiac rehabilitation are provided with no copay or coinsurance.
Inpatient Hospital See details
Aetna Medicare Signature Giveback (PPO) covers inpatient hospital services with no coinsurance, requiring a $350 daily copay for days 1 to 7 of acute stays (with unlimited additional days at no copay) and days 1 to 5 of psychiatric stays, followed by no copay for remaining days. Prior authorization is required, and certain services like non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Signature Giveback (PPO) with no coinsurance across all services. Patients will pay no copay for ambulatory surgical center and blood services, a $50 copay for outpatient substance abuse sessions, and copays ranging from $0 to $350 for outpatient hospital and observation services.
Partial Hospitalization See details
Aetna Medicare Signature Giveback (PPO) covers partial hospitalization services with a copay of either $60.00 or $145.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Signature Giveback (PPO) covers ground ambulance services with a $290 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. These fees are not waived if you are admitted to the hospital, and routine transportation services are not covered.
Emergency Services See details
Aetna Medicare Signature Giveback (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 featuring no coinsurance. Worldwide emergency services are also covered with no coinsurance up to a $250,000 maximum, requiring a $130 copay for emergency or urgent care and a $290 copay for worldwide emergency transportation.
Primary Care See details
Aetna Medicare Signature Giveback (PPO) offers primary care physician visits with no copay and no coinsurance, while specialist, podiatry, mental health, and psychiatric services carry a $50 copay and no coinsurance. Physical, occupational, and speech therapies require a $45 copay and no coinsurance, whereas chiropractic care is only partially covered with routine services excluded. Telehealth benefits are also covered with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Signature Giveback (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, memory fitness, and health education, though kidney disease education requires a 20% coinsurance and no copay. Non-covered 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/bathroom safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature Giveback (PPO) covers hearing services, offering routine exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $50 copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual limit per ear, though over-the-counter (OTC) options and specific prescription models like inner ear, outer ear, and over-the-ear are not covered.
Vision Services See details
Aetna Medicare Signature Giveback (PPO) covers vision services with no deductibles and no coinsurance, featuring eye exams with a copay ranging from $0 to $50 and a $50 annual maximum benefit. Eyewear, including lenses, frames, and contacts, is covered with no copay up to a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature Giveback (PPO), offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental for a $50 copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $500 yearly limit, but other diagnostic services, fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Signature Giveback (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs carry a $35 copay with no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature Giveback (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature Giveback (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay required for covered services. Depending on the specific item, coinsurance ranges from no coinsurance to 20%, with prosthetic devices and diabetic therapeutic shoes requiring a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Signature Giveback (PPO) covers diagnostic tests, procedures, and lab services with no copay and no coinsurance. Radiological services require prior authorization and feature a $0 minimum copay for diagnostic radiology, a $50 copay for outpatient X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Signature Giveback (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Signature Giveback (PPO) with no copay and no coinsurance. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature Giveback (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $213 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature Giveback (PPO) partially covers other services, offering chronic illness meal benefits, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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