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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 Fulton and Rockdale counties GA. 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 $285.00 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 annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using preferred pharmacies or preferred mail order services. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply fill. For higher-tier medications, cost sharing transitions to a percentage of the drug cost across all pharmacy and mail order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Additionally, Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care physician visits, while specialist visits require copays between $0 and $55. For hospital care, members pay no coinsurance, though inpatient stays require a $407 daily copay for the first several days and outpatient hospital copays range from $0 to $450. Emergency services are available with a $115 copay that is waived upon admission, while urgent care visits require a $40 copay. Routine dental, vision, and hearing exams are covered with no copay or coinsurance, alongside annual allowances of up to $100 for eyewear and $500 per ear for prescription hearing aids. Skilled nursing facility stays feature no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance. Additionally, durable medical equipment and dialysis services require a 20% coinsurance with no copay, and members receive a $15 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Elite (PPO) with no coinsurance, but require a $407 daily copay for days 1-6 for acute stays (no copay for days 7 and beyond) and days 1-5 for psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $450 for outpatient hospital services and $407 per stay for observation services. Ambulatory surgical center and blood services have 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 a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services under Aetna Medicare Elite (PPO) require prior authorization and cost a $295 copay with no coinsurance for ground transport, or a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services 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 and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $295.
Primary Care See details
Aetna Medicare Elite (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and psychiatric services require copays ranging from $0 to $55 and no coinsurance. Chiropractic and podiatry services are not covered, but telehealth benefits are available with a 20% coinsurance and copays from $0 to $55.
Preventive Services See details
Aetna Medicare Elite (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physicals, glaucoma screenings, and diabetes training. While kidney disease education has no copay and a 20% coinsurance, supplemental benefits like fitness programs have no copay or coinsurance, though services like personal emergency response systems, medical nutrition therapy, and weight management are not covered.
Hearing Services See details
Hearing services covered by Aetna Medicare Elite (PPO) with no deductible include routine exams and evaluations with no copay or coinsurance, while Medicare-covered exams require a $55 copay and no coinsurance. Prescription hearing aids are partially covered up to $500 per ear annually with no copay or coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) vision services are covered with no deductibles and no coinsurance, offering routine eye exams with no copay and Medicare-covered exams with a copay of $0 to $55. Eyewear, including contacts, eyeglasses, frames, and upgrades, is also covered with no copay and no coinsurance up to a combined annual limit of $100.
Dental Services See details
Aetna Medicare Elite (PPO) offers partially covered dental services, featuring a $55 copay and no coinsurance for Medicare-covered care, and no copay or coinsurance for routine exams, cleanings, and x-rays. Comprehensive services require no copay with 20% to 50% coinsurance up to a $500 annual maximum, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite (PPO), offering durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and a 0% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab work, and a $0 to $95 copay for procedures. Radiological services feature no copay but require coinsurance for x-rays, a $0 minimum copay for diagnostic radiology, and both a copay and a minimum 20% coinsurance for therapeutic radiation.
Home Health Services See details
Home health services are covered under the Aetna Medicare Elite (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Elite (PPO) with no coinsurance, but some services are not covered, including standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD). These non-covered services require copays ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite (PPO) partially covers other services with no copay and no coinsurance, including chronic illness meals, annual wellness exams, screening mammographies, additional gFOBT and FIT, and a $15 quarterly over-the-counter reimbursement allowance. Acupuncture is not covered under this benefit.
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