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Aetna Medicare SmartFit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare SmartFit (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare SmartFit (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare SmartFit (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Nebraska. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare SmartFit (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 SmartFit (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 SmartFit (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 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 $8000.00 (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 $8000.00 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 SmartFit (PPO) plan has a $590 deductible for prescription drugs. After meeting your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at a preferred pharmacy. In the initial coverage phase, you'll pay a copay or coinsurance until your total drug costs reach $2,000. Once you reach $2,000, you enter the catastrophic coverage phase, where you'll pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. You can expect no copay for services such as primary care physician visits, preventive services like annual physical exams, and many dental and vision services. Additionally, the plan covers hearing services with a maximum benefit of $1250 per ear annually, and offers coverage for home health services with no copay. This plan also covers emergency services, ambulance services, and diagnostic services. The plan covers a variety of other services, including durable medical equipment, dialysis, and home infusion services, but it's important to note that some services may require prior authorization or have coinsurance costs. Other services such as over-the-counter items and meal benefits have no copay.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay is $1,871. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $400, observation services have a $400 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare SmartFit (PPO) plan with a $55 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
The Aetna Medicare SmartFit (PPO) plan covers ambulance services, with a $350 copay for ground ambulance services and a 20% coinsurance for air ambulance services. 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 SmartFit (PPO). Emergency Services and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $350 copay; Urgently Needed Services has a $50 copay.
Primary Care See details
For Aetna Medicare SmartFit (PPO), primary care physician services have no copay, chiropractic services have a $20 copay, and occupational therapy services have a $35 copay. Physician specialist services have a copay between $0 and $35, and mental health specialty services have a $40 copay for both individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance with a copay between $0 and $50. Individual and group psychiatric sessions have a $40 copay, and opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services like health education, nutritional/dietary benefits, and wigs for hair loss related to chemotherapy are covered with no copay. The plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, or support for caregivers of enrollees. Kidney disease education services have a 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids, with a maximum benefit of $1250 per ear every year. Hearing exams and routine hearing exams have no copay, while fitting/evaluation for hearing aids and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare SmartFit (PPO) plan covers vision services, including eye exams and eyewear. Eye exams, including routine exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $300 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and no copay for 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $1,300 maximum plan benefit coverage amount per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare SmartFit (PPO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare SmartFit (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare SmartFit (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare SmartFit (PPO) plan, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartFit (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 and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, with no copay for either. 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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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.
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