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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 Select Counties in GA. This plan received an overall rating of 4 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 $350.00 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 generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply duration. For higher-tier medications, costs are based on coinsurance rather than flat copays across all pharmacy types. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits range from no copay up to a fifty-five dollar copay, while inpatient hospital stays require a daily copay for the first few days with no coinsurance. Outpatient hospital services and diagnostic tests are also covered with no coinsurance and variable copays, including no copay for lab services and outpatient X-rays. For routine wellness, the plan provides dental, vision, and hearing benefits with no deductibles, including no copay for annual eye exams, routine hearing exams, and preventive dental services. Prescription hearing aids, eyewear, and comprehensive dental services are partially covered with annual limits and minimal out-of-pocket costs. Additionally, members benefit from worldwide emergency coverage, no copay for home infusions, and a quarterly over-the-counter allowance.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $388 daily copay for days 1-7 of acute stays and a $407 daily copay for days 1-5 of psychiatric stays, with no copay for subsequent days. Unlimited additional acute days are covered at no copay, but 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 a $0 to $450 copay for outpatient hospital services, a $388 copay per stay for observation services, and a $40 copay for outpatient substance abuse sessions. Additionally, ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite (PPO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Elite (PPO), featuring a $295 copay for ground transport and a 20% coinsurance for air transport, both requiring prior authorization. Although some transportation services are covered, trips to plan-approved health-related locations and any 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, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency services are also covered up to a $250,000 limit with no coinsurance, requiring a $115 copay for emergency or urgent care and a $295 copay for emergency transportation.
Primary Care See details
Aetna Medicare Elite (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $55 copay and no coinsurance. Covered mental health, psychiatric, and physical therapies require copays ranging from $35 to $50 with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Elite (PPO) provides partially covered preventive services, featuring no copay and no coinsurance for annual physicals, glaucoma screenings, and select supplemental benefits, though kidney disease education requires a 20% coinsurance with no copay. Several supplemental options, such as weight management, nutritional/dietary benefits, and personal emergency response systems, are not covered.
Hearing Services See details
Aetna Medicare Elite (PPO) covers Medicare-covered hearing exams with a $55 copay and no coinsurance, as well as routine exams and evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear annually, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services covered by Aetna Medicare Elite (PPO) feature no deductibles and no coinsurance. Eye exams have a copay of up to $55, with no copay for yearly routine exams (up to a $50 limit), and eyewear is covered with no copay up to a combined $100 annual limit.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Elite (PPO), offering preventive and comprehensive care with no copay and 0% to 50% coinsurance up to a $1,500 annual limit, while Medicare-covered dental requires a $55 copay and no coinsurance. Fluoride treatments, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental 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 is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies feature no copay and range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services, outpatient X-rays, and diagnostic radiological services feature no copay. Therapeutic radiological services are subject to a minimum 20% coinsurance.
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 offered by Aetna Medicare Elite (PPO) with no coinsurance, though only some services are covered. Specifically, standard cardiac rehabilitation (with a $30.00 copay), intensive cardiac rehabilitation (with a $40.00 copay), pulmonary rehabilitation (with a $25.00 copay), and supervised exercise therapy for peripheral artery disease (with a $20.00 copay) are not covered.
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. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though 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 meal benefits, annual wellness exams, and a $15 quarterly over-the-counter reimbursement. Acupuncture is not covered under this plan.
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