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Aetna Medicare Gold Advantra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Gold 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 Gold Advantra (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Gold 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 Gold 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 Gold 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 Gold Advantra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $57.00. 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 $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 $10000.00 (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 $10000.00 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 Gold Advantra (PPO)
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Drug Coverage
The Aetna Medicare Gold Advantra (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you pay your deductible, you will pay a $0 copay for preferred generic drugs at preferred or mail-order pharmacies. For standard generic drugs and preferred brand drugs, you'll pay 22% and 25% coinsurance, respectively. After your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Gold Advantra (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $325 copay for the first seven days, and no copay for the remainder of the stay. Outpatient services have copays ranging from $0 to $325 depending on the service, while primary care visits have no copay. The plan also covers preventive, hearing, vision, and dental services. Many preventive services and routine exams have no copay, while hearing exams and vision exams have a copay. The plan also includes coverage for home health services with no copay, and covers a $75 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will also pay a $325 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Gold Advantra (PPO), including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, ASC services have no copay, individual and group sessions for outpatient substance abuse have a $75 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Gold 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 Gold Advantra (PPO) plan. Ground ambulance services have a $290 copay, while air ambulance services have 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 under the Aetna Medicare Gold Advantra (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Emergency Transportation has a $290 copay, and Urgently Needed Services have a $40 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Gold Advantra (PPO) plan covers Primary Care Physician Services with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $40 copay. Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services have a $40 copay, and Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services that may have a copay. Kidney disease education services have a 20% coinsurance, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Aetna Medicare Gold Advantra (PPO) covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids have a maximum benefit of $1250 per ear every year, and Prescription Hearing Aids (all types) have no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Gold Advantra (PPO) covers vision services, including eye exams with a copay between $0 and $40, and routine eye exams and other eye exam services with no copay. Eyewear is covered with no copay, with a combined maximum benefit of $275 per year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Gold Advantra (PPO) plan covers Medicare dental services with a $40 copay, oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with 20% to 50% coinsurance. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Aetna Medicare Gold Advantra (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Gold Advantra (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with no copay and 0-15% coinsurance, Prosthetic Devices with 50% coinsurance, and Medical Supplies with 0-50% coinsurance. Diabetic Equipment is covered with coinsurance, including Diabetic Supplies with 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300. Therapeutic Radiological Services have a coinsurance of at least 20%, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Gold 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 not covered by the Aetna Medicare Gold Advantra (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Gold Advantra (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Gold Advantra (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $75 every three months. The plan also covers Meal Benefits with no copay. Other services such as 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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