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Aetna Medicare Premier Plus 1 (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier Plus 1 (Regional 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 Plus 1 (Regional PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier Plus 1 (Regional PPO) is a Regional PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier Plus 1 (Regional 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 Plus 1 (Regional 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 Plus 1 (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $244.00. 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 has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
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 Plus 1 (Regional PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. However, those who qualify for the low-income subsidy (LIS) may have a reduced monthly premium.
Additional Benefits
The Aetna Medicare Premier Plus 1 (Regional PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $200 copay for days 1-5, and no copay for days 6-90, while outpatient services have copays that range from $0 to $200. The plan includes coverage for primary care visits with a $5 copay, preventive services with no copay for many services, and hearing, vision, and dental services, with no copay for many services. The plan also covers ambulance services with a $150 copay, and emergency services with a $125 copay. Home health services have no copay, and skilled nursing facility (SNF) services have no copay for days 1-20, and a $214 copay for days 21-100. Additionally, the plan offers benefits like OTC items with no copay and a $1,000 maximum plan benefit per year for in and out-of-network dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $200 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll also pay a $200 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $200, and observation services, with a $200 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse both have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier Plus 1 (Regional PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier Plus 1 (Regional PPO) plan. Ground and Air Ambulance Services each have a $150 copay, with no 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 Aetna Medicare Premier Plus 1 (Regional PPO). Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $25 copay, and Worldwide Emergency Transportation has a $150 copay; all other services have no coinsurance.
Primary Care See details
Aetna Medicare Premier Plus 1 (Regional PPO) covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $20 copay. Mental health and psychiatric services, additional telehealth benefits, and opioid treatment program services are covered with a copay of $40, while group sessions are covered with a $40 copay. Podiatry services and other health care professional services have varying copays.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services, including Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $1250 per ear every year, while OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Premier Plus 1 (Regional PPO) plan covers vision services, including eye exams with a copay between $0 and $20, and no copay for routine eye exams and other eye exam services. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, all with no copay, up to a combined maximum of $200 per year.
Dental Services See details
Dental services are covered under the Aetna Medicare Premier Plus 1 (Regional PPO) plan. Medicare Dental Services have no copay, and other dental services include 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, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $1,000 maximum plan benefit per year for in and out-of-network services.
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. 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 Premier Plus 1 (Regional PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment, with varying copays and coinsurance depending on the specific supply. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Premier Plus 1 (Regional PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $100, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier Plus 1 (Regional PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier Plus 1 (Regional PPO) plan. While the plan states that it covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, none of these sub-services are actually covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier Plus 1 (Regional PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Premier Plus 1 (Regional PPO) plan covers Over-the-Counter (OTC) Items with no copay, as well as a meal benefit and other services such as annual wellness exams and screening mammography, gFOBT, and FIT with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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