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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 Central Illinois. This plan received an overall rating of 3.5 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 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:
Sign up for Aetna Medicare Signature (PPO)
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Drug Coverage
The Aetna Medicare Signature (PPO) plan features an annual drug deductible of $615 before coverage begins for higher-tier medications. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, Tier 1 drugs require a copay starting at $2, while Tier 2 generics start at a $12 copay. For brand-name and specialty medications, this plan utilizes coinsurance instead of flat copays. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy options. Specialty medications in Tier 5 are limited to a one-month supply at the 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Signature (PPO) plan provides comprehensive medical coverage featuring no copay or coinsurance for primary care doctor visits and a $0 to $55 copay for specialists. If you require hospital care, inpatient acute stays have a $430 daily copay for days one through six and no copay for additional days, while emergency room visits require a $130 copay that is waived upon admission. Outpatient diagnostic lab services, outpatient X-rays, and home health services are also fully covered with no copays or coinsurance. For routine wellness, this plan offers no copays or coinsurance for most preventive services as well as routine dental, vision, and hearing exams. You will also benefit from helpful allowances, including up to $100 annually for eyewear and up to $500 per ear yearly for prescription hearing aids. Select preventive dental care like cleanings and exams are covered with no copay, making it easier and more affordable to manage your everyday health.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $430 daily copay for days 1 to 6 and no copay for additional days, while psychiatric care requires a $375 daily copay for days 1 to 6 and no copay for days 7 to 90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $435, observation services cost a $430 copay per stay, and outpatient substance abuse sessions have a $55 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Signature (PPO) plan with a copay of either $70.00 or $145.00 and no coinsurance, depending on the service. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (PPO) covers ground ambulance services with a $325 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Signature (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed care is available with a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with no coinsurance, requiring a $130 copay for emergency or urgent care and a $325 copay for emergency transportation.
Primary Care See details
Aetna Medicare Signature (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $55 copay and no coinsurance. Therapy, psychiatry, and podiatry services require a $50 to $55 copay and no coinsurance, telehealth has a $0 to $50 copay and 20% coinsurance, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Signature (PPO) with no copay and no coinsurance for most services like annual physicals and fitness programs, though kidney education requires a 20% coinsurance and no copay. Excluded sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional or dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing services with no deductible, featuring a $55 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum per ear, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no deductibles, offering routine eye exams and follow-up diabetic eye exams with no copays or coinsurance up to a $50 annual maximum. Eyewear, including contacts, eyeglasses, lenses, frames, and upgrades, is also covered with no copay or coinsurance up to a combined maximum of $100 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Signature (PPO), featuring a $55 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for select preventive care. Covered preventive benefits include up to four oral exams, two cleanings, and one X-ray per year, while fluoride, restorative, endodontic, periodontic, and oral surgery services 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. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Signature (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and no coinsurance to 20% coinsurance, though prosthetic devices carry a flat 20% coinsurance. Diabetic supplies are covered with no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO), featuring no copay for lab services and outpatient X-rays, and a $0 to $55 copay with no coinsurance for diagnostic procedures. Diagnostic radiological services have no copay, while therapeutic radiological services require a 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Signature (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Aetna Medicare Signature (PPO) with no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Other services covered by Aetna Medicare Signature (PPO) include annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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