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Aetna Medicare Signature (Regional PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Signature (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 Signature (Regional PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Signature (Regional PPO) is a Regional PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in New Jersey Counties: All. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Signature (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 Signature (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 Signature (Regional PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $139.00. 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 $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 (Regional PPO) plan features an annual prescription drug deductible of $615. For generic medications, members can save significantly by using preferred pharmacies or preferred mail order services, which offer no copay for both Tier 1 preferred generics and Tier 2 generics. Standard pharmacies and standard mail order options are also available with low copays, ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. For higher-tier medications, cost sharing transitions to coinsurance across all pharmacy and mail order types. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. This consistent cost-sharing structure helps you easily estimate your out-of-pocket costs for brand-name and specialty prescriptions.
Additional Benefits
The Aetna Medicare Signature (Regional PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay for annual physicals, routine eye exams, and preventive dental cleanings. Primary care visits require a low $10 copay, while specialist visits range from no copay to $50, with no coinsurance required for either. For emergency care, you will pay a $115 copay which is waived if admitted, while inpatient hospital stays require a daily copay for the first six days followed by no copay for subsequent days. Outpatient services, home health care, and diagnostic lab tests are highly accessible and frequently require no copay and no coinsurance. While specialized services like dialysis and durable medical equipment carry a 20% coinsurance, routine hearing exams and select eyewear are covered with no copay. This plan successfully balances everyday wellness and major medical coverage by utilizing clear copays and eliminating coinsurance for most standard doctor visits.
Inpatient Hospital See details
Aetna Medicare Signature (Regional PPO) covers inpatient hospital services with no coinsurance, requiring a $399 daily copay for days 1 through 6 of acute stays and a $346 daily copay for days 1 through 6 of psychiatric stays, followed by no copay for subsequent days. This benefit is partially covered, as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Signature (Regional PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also feature no copays. Outpatient hospital services require a copay of $0 to $375, observation services carry a $399 copay per stay, and outpatient substance abuse sessions have a $50 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Aetna Medicare Signature (Regional PPO) plan with a copay of either $70.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Signature (Regional PPO) covers ground and air ambulance services with a $280 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Signature (Regional PPO) plan 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 and no coinsurance, while worldwide emergency and urgent care are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $280.
Primary Care See details
Primary care services are covered by Aetna Medicare Signature (Regional PPO) with a $10 copay and no coinsurance for primary care visits, and a $0 to $50 copay with no coinsurance for specialists. Physical, occupational, and speech therapies require a $35 copay with no coinsurance, while mental health and psychiatric sessions cost a $50 copay with no coinsurance. Some chiropractic services are covered, though routine and other chiropractic services are not covered, and podiatry services are also not covered.
Preventive Services See details
Preventive Services are partially covered under Aetna Medicare Signature (Regional PPO), with no copay and no coinsurance for annual physicals, health education, and diabetes training, though kidney disease education requires a 20% coinsurance with no copay. Wigs for hair loss are covered with no copay or coinsurance up to $400 annually, but several sub-services are not covered, including medical nutrition therapy, weight management, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Signature (Regional PPO), featuring a $50 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are also partially covered for up to two devices per year with no coinsurance and copays ranging from no copay to $1,700, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Signature (Regional PPO) covers vision services with no coinsurance and no deductibles, offering routine and diabetic eye exams with no copay, and Medicare-covered exams with a $0 to $50 copay. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a $100 annual combined maximum, while eye exams have a $50 annual maximum benefit.
Dental Services See details
Aetna Medicare Signature (Regional PPO) dental services are partially covered, offering Medicare-covered dental services for a $50.00 copay and no coinsurance, alongside select preventive services like cleanings, oral exams, and X-rays for no copay and no coinsurance. However, several services are not covered under this plan, including fluoride treatments, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Signature (Regional PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Signature (Regional PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Signature (Regional PPO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment, medical supplies, and diabetic supplies have coinsurance ranging from no coinsurance to 20%, while prosthetic devices and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Signature (Regional PPO) with prior authorization required. Diagnostic tests and lab services have no coinsurance, with lab services requiring no copay and other diagnostic procedures ranging from a $0 to $50 copay. Outpatient X-rays require a $50 copay, diagnostic radiological services start at no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Signature (Regional 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 the Aetna Medicare Signature (Regional PPO) plan, but in practice only some services are covered because cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Signature (Regional PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the Aetna Medicare Signature (Regional PPO) plan, which offers a meal benefit for chronic illness, annual wellness exams, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. Acupuncture and Over-the-Counter (OTC) items are not covered under this plan.
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