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Aetna Medicare Premier Advantra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Advantra (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier Advantra (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Advantra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Northern. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Advantra (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 Premier Advantra (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 Premier Advantra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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 Premier Advantra (PPO)
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Drug Coverage
The Aetna Medicare Premier Advantra (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D-covered drugs. If you qualify for the low-income subsidy, your monthly premium will be $13.40.
Additional Benefits
The Aetna Medicare Premier Advantra (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services with varying copays, and partial hospitalization. Emergency and primary care services are covered with copays, and preventive services are available with no copay. This plan also includes coverage for hearing, vision, and dental services, with specific copays and maximum benefits. Additionally, the plan covers home infusion, dialysis, medical equipment, diagnostic services, and home health services.
Inpatient Hospital See details
Inpatient Hospital services are covered by Aetna Medicare Premier Advantra (PPO), with a copay of $275 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $250 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $275, Observation Services have a $275 copay, and Ambulatory Surgical Center Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Advantra (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier Advantra (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Premier Advantra (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Transportation has a $290 copay; all of these services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $20 copay and no coinsurance. Physician Specialist Services have a $25 copay. Mental Health Specialty Services, including individual and group sessions, have a $30 copay. Podiatry Services and Routine Foot Care have a $20 copay. Other Health Care Professional services have a copay between $0 and $25. Psychiatric Services, including individual and group sessions, have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay and no coinsurance. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75. Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, along with additional preventive services, Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit; all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other services like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $1,000 per ear every year, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Premier Advantra (PPO) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams are limited to one per year with no copay, and other eye exam services have no copay and are unlimited. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Aetna Medicare Premier Advantra (PPO) covers a maximum of $2,250 per year for dental services, with a $25 copay for Medicare Dental Services, and no copay for oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatment, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier Advantra (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Premier Advantra (PPO) plan, including Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetic Devices with a 20% coinsurance, Medical Supplies with a 0-20% coinsurance and no copay, and Diabetic Equipment with a 0-20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier Advantra (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay of $0-$75, lab services with no copay, and diagnostic radiological services with a copay of at most $200. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Premier Advantra (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Premier Advantra (PPO) plan, but the specific services of 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 copay information can be found below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Advantra (PPO) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a copay of $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, 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, 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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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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