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Aetna Better Health Premier Plan (Medicare-Medicaid Plan)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Better Health Premier Plan (Medicare-Medicaid Plan). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Better Health Premier Plan (Medicare-Medicaid Plan) in 2025, please refer to our full plan details page.
Aetna Better Health Premier Plan (Medicare-Medicaid Plan) is a Medicare-Medicaid Plan plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wayne, Macomb counties, Southwest Michigan region. The overall rating for this plan is not yet available for 2025.
It's important to know that Aetna Better Health Premier Plan (Medicare-Medicaid Plan) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Aetna Better Health Premier Plan (Medicare-Medicaid Plan)is a Medicare-Medicaide (MMP) plan. This means you can only enroll in this plan if you meet specific criteria for both medicare and medicaid. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Better Health Premier Plan (Medicare-Medicaid Plan).
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 Better Health Premier Plan (Medicare-Medicaid Plan), 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below 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 Better Health Premier Plan (Medicare-Medicaid Plan)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Better Health Premier Plan (Medicare-Medicaid Plan) has a $0 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), you will pay $0 for your Part D drugs. During the initial coverage phase, you will pay the costs for your drugs until your total drug costs reach $2,000. Once you reach this amount, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Better Health Premier Plan (Medicare-Medicaid Plan) offers a wide range of benefits with varying cost structures. Many services, like emergency services, primary care, dialysis, medical equipment, and home health services, are covered with no copay. The plan also provides coverage for vision, hearing, and dental services, and offers an over-the-counter (OTC) allowance of $60 per month. However, some services have limitations. Inpatient and outpatient services, partial hospitalization, and skilled nursing facilities require prior authorization. Some services have no copay, while others do not cover the full cost.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, though Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Prior authorization is required for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient substance abuse services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Better Health Premier Plan, but ground and air ambulance services, and transportation services to plan-approved health-related locations are not covered. Transportation services to any health-related location are covered with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Better Health Premier Plan, with no copay or coinsurance. However, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are not covered.
Primary Care See details
Primary care physician services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services are covered with no coinsurance or copay for occupational therapy and physical therapy services. Chiropractic services are partially covered, with routine chiropractic care not covered, and mental health specialty services and psychiatric services are partially covered, with individual and group sessions not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered zero-dollar preventive services, Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling (42 visits), Fitness Benefit (Memory Fitness), Glaucoma Screening, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual physical exams, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams and prescription hearing aids, but routine hearing exams and over-the-counter hearing aids are not covered. Fitting/evaluation for hearing aids is covered for 2 visits every year, and prescription hearing aids (all types) are covered once every 5 years.
Vision Services See details
Vision Services include coverage for routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, but upgrades are not covered. Routine eye exams are covered once every two years. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable & fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs. Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis Services are covered by the Aetna Better Health Premier Plan (Medicare-Medicaid Plan). There is no copay or coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Better Health Premier Plan, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefit, both with no copay and no coinsurance. Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are not covered by the Aetna Better Health Premier Plan (Medicare-Medicaid Plan) as the plan does not cover Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, or Outpatient X-Ray Services. Prior authorization is required for these services.
Home Health Services See details
Home Health Services are covered by the Aetna Better Health Premier Plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered, but Additional Home Health Services are covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. The plan covers additional days beyond Medicare-covered SNF stays, but non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Better Health Premier Plan (Medicare-Medicaid Plan) covers Over-the-Counter (OTC) items with a maximum benefit coverage of $60.00 every month. Other covered services include meal benefits, other services, and private duty nursing services with a limit of 16 hours per day. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Tobacco Cessation Counseling for Pregnant Women, Respiratory Care Services, Family Planning Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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