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Aetna Medicare Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Elite (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite (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 Elite (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 Elite (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 has a $1500.00 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 $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:
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Drug Coverage
The Aetna Medicare Elite (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when filling prescriptions through a preferred pharmacy or preferred mail order service. If you choose a standard pharmacy or standard mail order instead, a one-month supply costs a low $2 copay for Tier 1 and $12 for Tier 2. For higher-tier medications, coverage costs transition to coinsurance. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These percentage-based costs remain consistent across all preferred and standard retail pharmacies as well as mail order options.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage for core medical services, featuring no copay for primary care doctor visits and copays ranging from no copay to $45 for specialists. For hospital care, inpatient stays require a $390 daily copay for the first five days, while outpatient services range from no copay up to a $390 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgent care services require a $50 copay. This plan also includes strong coverage for routine care, offering dental cleanings, vision exams, and hearing tests with no copays or coinsurance. Beneficiaries can take advantage of annual allowances for eyewear and prescription hearing aids, as well as home health services with no copay. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and diagnostic lab services are covered with no copay.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) covers inpatient hospital services with no coinsurance, featuring a $390 daily copay for days 1 through 5 of acute care and a $1,871 copay per stay for psychiatric care. While unlimited additional days of acute care are covered with no copay, non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $390 copay and observation services with a $390 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with no coinsurance, though a copay of either $55.00 or $145.00 applies depending on the service. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ambulance services with a $345 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required for all ambulance services. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Elite (PPO) with a $130 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum benefit with no coinsurance and copays ranging from $130 to $345.
Primary Care See details
Aetna Medicare Elite (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $45 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services under the Aetna Medicare Elite (PPO) are generally covered with no copay and no coinsurance, including annual physical exams, although kidney disease education requires a 20% coinsurance with no copay. This benefit is partially covered because sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, counseling, and home safety devices are not covered.
Hearing Services See details
Aetna Medicare Elite (PPO) covers hearing exams with no copay and no coinsurance, which includes one routine exam and one fitting evaluation per year. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,250 maximum per ear annually, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers vision services with no copays, no coinsurance, and no deductibles for both exams and eyewear. This benefit includes one routine eye exam per year with a $50 maximum benefit, alongside a combined $200 annual allowance for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (PPO), featuring Medicare-covered dental care for a $45 copay and no coinsurance, plus routine exams, cleanings, and X-rays with no copay and no coinsurance. Comprehensive services such as fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, oral surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and infusion drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan with no copay and a 20% coinsurance, subject to prior authorization requirements.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (PPO), with prior authorization required. Diagnostic procedures carry a $0 to $20 copay with no coinsurance, lab services have no copay, and radiological services range from a $15 copay for X-rays to a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Elite (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Elite (PPO) features no coinsurance for cardiac rehabilitation services, meaning some services are covered; however, cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (PPO) with no coinsurance and do not require a prior three-day inpatient hospital stay, though prior authorization is necessary. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by the Aetna Medicare Elite (PPO), which offers an annual wellness exam, screening mammography, and additional gFOBT and FIT with no copay and no coinsurance. However, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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