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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 Central and Northwest AR Counties. 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 $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 $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 Elite (PPO) plan features an Enhanced Alternative drug benefit with a $615.00 prescription drug deductible. Once this deductible is met, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies. For Tier 2 standard generics, Tier 3 preferred brands, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy (Extra Help) can receive a Part D premium reduction, lowering their cost to $0.00.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, home health services, and most preventive care. For emergency situations, members pay a $115 copay for emergency room visits, which is waived upon hospital admission, and a $40 copay for urgent care. Inpatient hospital stays require a copay of $340 per day for the first seven days, while outpatient services range from no copay up to a $340 copay with no coinsurance. Specialty benefits under this plan include comprehensive dental coverage up to $3,000 annually with 20% to 50% coinsurance, alongside routine dental, vision, and hearing exams featuring no copay. Vision eyewear is covered up to $250 annually, and prescription hearing aids are covered up to $500 per ear per year, both with no copay. Additionally, diagnostic lab services and over-the-counter items require no copay, while durable medical equipment and dialysis services require up to 20% coinsurance with no copay.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) partially covers inpatient hospital benefits with no coinsurance, requiring a copay of $340 per day for days 1 to 7 of acute care and $407 per day for days 1 to 5 of psychiatric care, with no copay for subsequent days. 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, featuring copays that range from no copay for ambulatory surgical center and blood services up to $340 for outpatient hospital and observation services. Outpatient substance abuse individual and group sessions are also covered with a $35 copay.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization benefits with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) partially covers ambulance and transportation services, as transportation services to plan-approved and any health-related locations are not covered. Covered ground ambulance services require a $330 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite (PPO) 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 services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $330.
Primary Care See details
Aetna Medicare Elite (PPO) provides primary care physician services with no copay and no coinsurance, while other covered services like specialist visits, physical therapy, and mental health services feature copays up to $35 with no coinsurance. Additional telehealth services are covered with a 20% coinsurance and copays from $0 to $40, but routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (PPO), with most covered services, including annual physicals and glaucoma screenings, requiring no copay and no coinsurance. Kidney disease education is covered with a 20% coinsurance and no copay, while several sub-services, such as weight management, nutritional benefits, and in-home safety assessments, are not covered.
Hearing Services See details
Aetna Medicare Elite (PPO) provides partially covered hearing services with no deductible, including annual routine exams and fittings for no copay and no coinsurance, and Medicare-covered exams for a $35 copay and no coinsurance. Prescription hearing aids (all types) are covered up to $500 per ear annually with no copay and no coinsurance, while OTC hearing aids and prescription aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers vision services with no copay, coinsurance, or deductible, including routine and diabetic eye exams up to a $50 annual limit. Additionally, the plan covers eyewear, such as contacts, lenses, frames, and upgrades, with no copay or coinsurance up to a combined maximum of $250 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (PPO), offering Medicare-covered dental for a $35 copay and no coinsurance, alongside preventive exams, cleanings, and x-rays with no copay or coinsurance. Other services are covered up to a $3,000 annual maximum with 20% to 50% coinsurance and no copay, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (PPO), requiring prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Elite (PPO) plan with 20% coinsurance and no copay. Prior authorization is required to receive these benefits.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays. Members will pay a coinsurance ranging from no coinsurance up to 20% depending on the specific item, and prior authorization is required.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services, with prior authorization required. Lab services and outpatient X-rays have no copay or coinsurance, while diagnostic procedures require a $0 to $95 copay and diagnostic radiology requires a copay of up to $300, both with no coinsurance. Therapeutic radiological services require a 20% coinsurance and no copay.
Home Health Services See details
Aetna Medicare Elite (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Elite (PPO) plan. In practice, none of the associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Elite (PPO) with prior authorization, though additional days beyond Medicare-covered stays are not covered. This benefit features no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Aetna Medicare Elite (PPO) partially covers Other Services, as Dual Eligible SNPs with Highly Integrated Services are not covered. Covered acupuncture services require a $20 copay and no coinsurance, while over-the-counter items, meal benefits, wellness exams, and select screenings are offered with no copay and no coinsurance.
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