A non-government entity
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 Missouri/Illinois. 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 $10100.00 (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 $10100.00 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:
Sign up for Aetna Medicare Elite (PPO)
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 Medicare Elite (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members pay no copay when utilizing preferred pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order options are used, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copayments. Tier 3 (Preferred Brand) medications require a 24% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications require a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order channels.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage for essential medical services, featuring no copay for primary care visits and a copay of up to $45 for specialists. For hospital care, inpatient stays require a $380 daily copay for the first six days with no copay thereafter, while outpatient hospital services carry a copay of up to $325. Emergency room visits have a $130 copay, which is waived if you are admitted, and urgent care is available for a $45 copay. This plan also includes key supplemental benefits to reduce out-of-pocket costs, such as routine dental, vision, and hearing exams with no copay. Vision care features a $100 annual eyewear allowance, and prescription hearing aids are covered up to $500 per ear yearly. Additionally, diagnostic lab work, outpatient x-rays, and home health services are covered with no copay or coinsurance, while specialized treatments like dialysis require a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $380 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of up to $325, observation services have a $380 copay per stay, and outpatient substance abuse services carry a $45 copay, with prior authorization required for most of these benefits.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite (PPO) with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ground ambulance services with a $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are not covered under this plan.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $45 copay and no coinsurance. Worldwide emergency and urgent services are also covered with no coinsurance up to a $250,000 maximum, featuring a $130 copay for care and a $300 copay for emergency transportation. These emergency and urgent care copays do not count toward any plan-level deductible.
Primary Care See details
Aetna Medicare Elite (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services carry a $0 to $45 copay and no coinsurance. Chiropractic services are not covered, but telehealth benefits are covered with a $0 to $45 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, health education, memory fitness, and select screenings, though kidney disease education requires a 20% coinsurance. Supplemental services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered under this plan.
Hearing Services See details
Aetna Medicare Elite (PPO) covers hearing services with a $45 copay and no coinsurance for Medicare-covered exams, alongside annual routine exams and fitting evaluations at no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear yearly, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (PPO) with no copay, no coinsurance, and no deductible for eye exams and eyewear. This includes one routine eye exam per year with a $50 annual limit, plus a $100 yearly allowance for eyewear like contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (PPO), offering Medicare-covered dental services for a $45.00 copay and no coinsurance, plus select preventive care like oral exams, cleanings, and x-rays with no copay and no coinsurance. However, fluoride, other diagnostic or preventive services, restorative services, 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 and no coinsurance, although prior authorization is required. Under this benefit, covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Elite (PPO) plan with no copay and coinsurance ranging from no coinsurance to 20% for durable medical equipment, prosthetics, and diabetic supplies. Diabetic therapeutic shoes and inserts require a $10 copay, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (PPO) with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay of $0 to $45, while lab services, outpatient x-rays, and diagnostic radiological services have no copay. Therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite (PPO) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Elite (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Elite (PPO), offering covered annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved