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Aetna Medicare Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (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 (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (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 Signature (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 (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 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $500.00 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 Signature (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options require a copay starting at $2 for Tier 1 and $12 for Tier 2. Brand-name and specialty medications are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both incur a 25% coinsurance across all pharmacy networks. Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive medical coverage with structured copayments and no coinsurance for many essential services. Primary care visits require a $15 copay, while specialist visits range from no copay to a $55 copay. Emergency room visits have a $115 copay, and inpatient acute hospital stays require a $385 daily copay for days one through seven with no copay for additional days. This plan also includes routine vision, hearing, and preventive dental care with no copay and no coinsurance. Members benefit from a $100 annual eyewear allowance, up to $500 for prescription hearing aids, and home health services covered with no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1 to 7 of acute stays and a $350 daily copay for days 1 to 5 of psychiatric stays. There is no copay for additional days of acute care, though non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring no copay and no coinsurance for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $385, observation services require a $385 copay per stay, and outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by the Aetna Medicare Signature (PPO) plan, with copayments ranging from no copay to $110 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgent care with a $40 copay, with no coinsurance or deductible required for either. Worldwide emergency and urgent services are also covered up to a $250,000 limit with no coinsurance, featuring a $115 copay for emergency or urgent care and a $300 copay for emergency transportation.
Primary Care See details
Primary Care benefits under the Aetna Medicare Signature (PPO) are covered with no coinsurance for most services, including a $15 copay for primary care, a $35 copay for therapy services, and copays between $0 and $55 for specialists. Mental health, psychiatric, and opioid treatment services require a $50 copay with no coinsurance, while telehealth services incur a 20% coinsurance and chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Signature (PPO) are partially covered with no copay and no coinsurance for annual physicals, screenings, and select wellness benefits, though kidney disease education requires a 20% coinsurance and no copay. Sub-services not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (PPO) covers Medicare-covered hearing exams with no deductible for a $55 copay and no coinsurance, while annual routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum, though over-the-counter hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with a $0 to $55 copay and eyewear with no copay. Routine eye exams are covered up to a $50 annual maximum, and a combined $100 annual allowance is provided for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Signature (PPO) offers partially covered dental services, featuring a $55 copay and no coinsurance for Medicare-covered dental services, which require prior authorization. Covered preventive care includes oral exams, cleanings, and dental X-rays with no copay and no coinsurance. However, fluoride, other diagnostic or preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance, 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 Signature (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO) with no copays, though coinsurance ranges from no coinsurance to 20% depending on the item, with diabetic shoes and inserts requiring no coinsurance. Prior authorization is required for durable medical equipment, prosthetics, and diabetic services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Signature (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, no copay for lab tests, and copays from $0 to $20 for procedures, while radiological services require a $30 copay for X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Aetna Medicare Signature (PPO) covers home health services 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 (PPO) with no copay and no coinsurance, although in practice, sub-services such as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits under Aetna Medicare Signature (PPO) are covered with no coinsurance and require prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20 and a $194 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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