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Aetna Medicare Advantra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare 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 Advantra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare 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 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare 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 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 Advantra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 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 $6300.00 (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 $6300.00 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 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service for up to a three-month supply. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For higher-tier medications, cost-sharing transitions to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Specialty drugs under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Advantra (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist consultations and physical therapy require a $25 copay, while emergency room visits carry a $150 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay of $295 for the first six days of acute care, with no copay required for the remaining days of the stay. Routine dental, vision, and hearing exams are highly accessible with no copay or coinsurance under this plan. Additional benefits include a $200 annual allowance for eyewear, a $1,000 annual limit per ear for prescription hearing aids, and comprehensive dental coverage up to $2,000 with 20% to 50% coinsurance. Members also receive up to $75 every three months for over-the-counter health items with no copay and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Advantra (PPO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $295 for days 1 through 6 of acute stays and $250 for days 1 through 5 of psychiatric stays, with no copay for remaining days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Advantra (PPO) with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a copay of $0 to $295, observation services cost a $295 copay per stay, and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Aetna Medicare Advantra (PPO) covers partial hospitalization with a copay of either $70.00 or $180.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Advantra (PPO) covers ground ambulance services with a $290.00 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. For transportation benefits, some services are covered but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Advantra (PPO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency and urgent care is covered up to a $250,000 limit with no coinsurance and copays ranging from $150 to $290.
Primary Care See details
Primary care benefits under Aetna Medicare Advantra (PPO) offer primary care visits with no copay and no coinsurance, while specialists, physical therapy, and occupational therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $30 copay and no coinsurance, but podiatry and routine chiropractic services are not covered. Telehealth services are also available with a 20% coinsurance and copays ranging from $0 to $30.
Preventive Services See details
Aetna Medicare Advantra (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, glaucoma screenings, diabetes training, and fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional or dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling services.
Hearing Services See details
Aetna Medicare Advantra (PPO) provides hearing services with a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for one routine exam and fitting evaluation annually. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual limit per ear, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Advantra (PPO) covers vision services with no deductibles and no coinsurance, offering eye exams with a copay of $0 to $25, and routine annual exams with no copay. Eyewear, including contacts, lenses, and frames, is covered with no copay up to a combined annual maximum benefit of $200.
Dental Services See details
Aetna Medicare Advantra (PPO) covers Medicare-covered dental services with a $25 copay and no coinsurance, and preventive services like exams, cleanings, and x-rays with no copay and no coinsurance. Comprehensive dental benefits are partially covered up to a $2,000 annual limit with no copay and 20% to 50% coinsurance, excluding fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Advantra (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Advantra (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Advantra (PPO) with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, and diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Advantra (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and tests range from no copay to a $75 copay with no coinsurance, while lab services and diagnostic radiological services feature no copay and no coinsurance. Outpatient X-rays require a $10 copay with coinsurance, and therapeutic radiological services carry a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Advantra (PPO) provides coverage for home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Aetna Medicare Advantra (PPO) covers Cardiac Rehabilitation Services with no coinsurance. Covered services require a copay, which is $20 for cardiac and intensive cardiac rehabilitation, $15 for pulmonary rehabilitation, and $25 for supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Aetna Medicare Advantra (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Advantra (PPO) partially covers other services with no copay and no coinsurance for covered benefits, which include chronic illness meals, annual wellness exams, additional cancer screenings, and up to $75 every three months in over-the-counter items. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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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.
* 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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