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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/Southern 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 $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 generic and Tier 2 generic medications, there is no copay when using preferred pharmacies or preferred mail-order services. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy options. While Tier 3 and Tier 4 drugs allow for multi-month supplies, Tier 5 specialty drugs are restricted to a one-month supply.
Additional Benefits
The Aetna Medicare Signature (PPO) plan offers comprehensive coverage with predictable costs, featuring no copay for primary care visits and specialist copays ranging up to $55. For inpatient hospital stays, there is no coinsurance, though you will pay a daily copay of $405 for acute care days 1 through 6, with no copay for days 7 and beyond. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgently needed care carries a $40 copay. Routine preventive care, home health services, and annual wellness exams are available with no copay and no coinsurance. The plan also covers routine hearing and vision exams with no copay, alongside a $500 annual hearing aid allowance per ear and a $100 limit for eyewear. Preventive dental services like cleanings and oral exams also feature no copay, though comprehensive dental treatments, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Aetna Medicare Signature (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, there is a $405 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $345 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered, as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Signature (PPO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services carry a copay ranging from $0 to $485, observation services cost a $405 copay per stay, and outpatient substance abuse sessions require a $55 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Signature (PPO) with a copay of $70 or $110 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services under the Aetna Medicare Signature (PPO) plan are partially covered, requiring prior authorization for ambulance services which cost a $360 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Signature (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays of $115 for emergency or urgent care and $360 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. Other services like physical therapy, occupational therapy, mental health, and podiatry require copays ranging from $35 to $55 and no coinsurance. For chiropractic services, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Signature (PPO) provides preventive services with no copay and no coinsurance for most covered care, such as annual physical exams and screenings, though kidney disease education has no copay and a 20% coinsurance. This benefit is partially covered because several sub-services, including weight management programs, alternative therapies, in-home support, and personal emergency response systems, are not covered.
Hearing Services See details
Aetna Medicare Signature (PPO) covers hearing services with no deductible, offering routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams carry a $55 copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (PPO) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This includes a maximum annual benefit of $50 for eye exams, including one routine exam per year, and a combined $100 annual limit for eyewear like contacts and eyeglasses.
Dental Services See details
Aetna Medicare Signature (PPO) offers partial coverage for dental services, featuring Medicare-covered dental care for a $55 copay and no coinsurance. Preventive services like oral exams (up to four per year), cleanings (up to two per year), and dental X-rays (one per year) are available with no copay and no coinsurance. However, fluoride, other diagnostic services, and all comprehensive treatments—including restorative, endodontic, and orthodontic 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 have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Signature (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Signature (PPO), which offers durable medical equipment (DME), medical supplies, and prosthetic devices with no copay and coinsurance ranging from no coinsurance to 20%. Additionally, diabetic supplies feature no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (PPO) with prior authorization required. Diagnostic tests and procedures have no coinsurance and a $0 to $55 copay, lab services and outpatient x-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
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 offered with no coinsurance under Aetna Medicare Signature (PPO), but only some services are covered because standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Signature (PPO) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
Aetna Medicare Signature (PPO) partially covers other services, offering an annual wellness exam, screening mammography, and additional gFOBT and FIT 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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