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Aetna Medicare Silver Back (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Silver Back (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Silver Back (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Silver Back (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 Silver Back (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 Silver Back (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 Silver Back (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 $35.00. 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 $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 $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 Silver Back (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, there is no copay at preferred pharmacies and mail order pharmacies, and a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance, while preferred and non-preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Silver Back (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services may have copays up to $300. Primary care visits are covered with no copay, and preventive services, including an annual physical exam, are also covered with no copay. Additional benefits include coverage for hearing, vision, and dental services. Hearing exams have a $35 copay, and vision services have a $0-$35 copay. Dental services, including oral exams and cleanings, have no copay. The plan also covers ambulance, emergency, and home health services, but some services may require coinsurance or prior authorization.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered under the Aetna Medicare Silver Back (PPO) plan. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, the copay is $350 for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay of $0-$300, Observation Services with a $300 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $45 copay for both Individual and Group Sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Silver Back (PPO) plan with no copay, but prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Silver Back (PPO) plan. Ground ambulance services have a $290 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 Silver Back (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $290 copay.
Primary Care See details
The Aetna Medicare Silver Back (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a $35 copay. Physician specialist services have a copay between $0 and $35, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services have a $40 copay, while podiatry services and other health care professional services vary in cost. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50.
Preventive Services See details
The Aetna Medicare Silver Back (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, are covered with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing exams have a $35 copay, while 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 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Aetna Medicare Silver Back (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with no copay. Eyewear has a combined maximum benefit of $255 every year for both in-network and out-of-network services.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, 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, all with no copay. Other services, including maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,000 maximum benefit per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Silver Back (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Silver Back (PPO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a coinsurance of 20%, and Medical Supplies have a coinsurance of 0% to 20%. Diabetic Supplies have a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Silver Back (PPO) plan, including diagnostic procedures/tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay of up to $295, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Silver Back (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Silver Back (PPO) plan, but the specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. The plan has a copay for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Silver Back (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional and non-Medicare covered SNF days are not covered.
Other Services See details
The Aetna Medicare Silver Back (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay, and a $90 maximum plan benefit coverage amount every three months. 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 are not covered.
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