A non-government entity
Aetna Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Choice (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeast Texas Non Metro. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice (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 Choice (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 Choice (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $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:
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Drug Coverage
The Aetna Medicare Choice (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, there is no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 22% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers coverage for a variety of healthcare services with varying costs. Many services, including primary care visits, preventive services, and outpatient blood services, have no copay. Other services like inpatient hospital stays, emergency services, and specialist visits have copays, with the specific amount depending on the service. The plan also covers hearing, vision, and dental services, with no copays for some services like routine eye exams and dental x-rays. This plan also provides coverage for home health services with no copay, and covers durable medical equipment with coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric care, requires prior authorization and has a copay of $300 for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital acute are covered with no copay, while non-Medicare covered stays and upgrades for inpatient hospital acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered, with copays ranging from $0 to $325. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, but requires prior authorization. The copay for this benefit is $70.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Choice (PPO) plan. Ground Ambulance Services have a $300 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for these services.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, and covers chiropractic services with a $15 copay. Occupational therapy services have a $30 copay, while physician specialist services have a copay between $0 and $30. Mental health and psychiatric services, including individual and group sessions, have a $30 copay. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services have a $30 copay, while routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Choice (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to a maximum of $500 per year, but OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Choice (PPO) plan covers vision services, including eye exams and eyewear. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum of $300 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay. Oral exams and dental x-rays have no copay, while prophylaxis (cleaning) has no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%. Orthodontic services have a maximum plan benefit coverage of $2500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Choice (PPO) plan, with a $35 copay for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Choice (PPO). You will pay 20% coinsurance for this service, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Choice (PPO), including durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, while Diabetic Supplies have a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, and Lab Services with no copay. Diagnostic Radiological Services have a copay of at most $375, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan. However, the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Choice (PPO), but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Choice (PPO) plan covers Over-the-Counter (OTC) Items with no copay. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, 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. Other 1 and Other 2 services are covered with no copay.
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