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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 2025, 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 Central and Northwest AR Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
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 $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $14000.00 (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 $14000.00 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 has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay a copay or coinsurance for your medications depending on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, but have a $12 copay at standard pharmacies and standard mail order. In the initial coverage phase, you'll pay these costs until your total drug costs reach $2,000. Once you reach that amount, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will have no copay.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with varying copays. Emergency services, primary care, and preventive services are covered, often with no copay. The plan also includes benefits for hearing, vision, and dental services, with specific copays or coinsurance amounts. Additional benefits include coverage for ambulance services, home health services, and skilled nursing facilities. You'll also find coverage for home infusion, dialysis services, medical equipment, diagnostic and radiological services, and cardiac rehabilitation. This plan also offers other services like acupuncture and over-the-counter items, with some services requiring copays or coinsurance, and exclusions apply.
Inpatient Hospital See details
The Aetna Medicare Elite (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For inpatient hospital-acute, you'll pay a $340 copay for days 1-7, and no copay for days 8-90, while inpatient hospital-psychiatric has a $407 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Elite (PPO) plan, including 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 $340, observation services have a $340 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group outpatient substance abuse sessions have a copay between $35 and $35.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Elite (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a $330 copay, while Air Ambulance Services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a $330 copay, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, and Occupational Therapy Services with a $35 copay and no coinsurance. It also covers Physician Specialist Services with a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services with a $35 copay and no coinsurance. Mental Health and Psychiatric Specialty Services have a $35 copay for individual and group sessions. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $35. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams, with no copay. The plan also covers additional preventive services, including health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay. Kidney disease education services have a 20% coinsurance. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, counseling services, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Elite (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $315 per year.
Dental Services See details
The Aetna Medicare Elite (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic services with no copay, as well as orthodontics, with a maximum plan benefit of $2,800 per year, but maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare dental services have a $35 copay and require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Elite (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the Aetna Medicare Elite (PPO) plan. Durable Medical Equipment has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance with no copay. Medical supplies have a 20% coinsurance with no copay. Diabetic supplies have a coinsurance between 0% and 20% with no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests (with a copay between $0 and $95), lab services (with no copay), and all radiological services. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Elite (PPO), but the plan does not specify the cost sharing details for these services. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Under "Other Services", acupuncture has a $20 copay, and over-the-counter items and meal benefits have no copay. The plan also covers annual wellness exams and screening mammograms, and gFOBT and FIT with no copay. However, 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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