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Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Illinois/Metro St Louis - Illinois. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.80. 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 $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 $8950.00 (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 $8950.00 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 Premier (PPO) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance. After your total drug costs reach $2,000, 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 is $22.80.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a copay, and outpatient services with varying copays depending on the service, and emergency services with a copay. Primary care, preventive services, vision, and dental services are also covered. This plan offers additional benefits such as hearing services, home health services, and skilled nursing facility services with copays or coinsurance. Additionally, the plan covers ambulance services with a copay and coinsurance, and diagnostic and radiological services with copays and coinsurance. The plan offers additional benefits such as home infusion bundled services, dialysis services, and medical equipment, with the specifics of each service varying.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with a $275 copay for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are also covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, with specific copays depending on the service: Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $275 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual Sessions for Outpatient Substance Abuse have a $40 copay, Group Sessions for Outpatient Substance Abuse have a $30 copay, and Outpatient Blood Services have no copay. This plan also includes an enhanced benefit with a waived deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Premier (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $325 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 Premier (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation has a $325 copay; all have no coinsurance.
Primary Care See details
Primary Care includes coverage for primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $30, and mental health specialty services with a copay between $30 and $40. This plan also covers podiatry services and other healthcare professional services, both with copays ranging from $30 to $40. Additionally, psychiatric services are covered with a copay between $30 and $40, physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. The plan also covers opioid treatment program services with a copay between $40.00.
Preventive Services See details
The Aetna Medicare Premier (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit coverage of $2000 per year, per ear, with no copay for hearing aids of all types. Prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams and eyewear each have no copay. Eyewear has a combined maximum plan benefit of $390.00 per year.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers a variety of dental services, including 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 with no copay. This plan also offers a maximum benefit of $1500 per year for in-network and out-of-network services. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Aetna Medicare Premier (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Premier (PPO). You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Premier (PPO) plan. Durable Medical Equipment (DME) has no copay with a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance of 0-20%. Diabetic Supplies have a coinsurance of 0-20% and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $30, and lab services with no copay. Diagnostic radiological services have a copay up to $110, while therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance. However, 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 (PPO) plan. However, 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Premier (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. 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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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.
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