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 El Paso County. 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 $15.00. 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 $6750.00 (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 $6750.00 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:
Sign up for Aetna Medicare Choice (PPO)
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Drug Coverage
The Aetna Medicare Choice (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay for your prescriptions based on the drug tier and the pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies or through mail order. Standard generic drugs have a 22% coinsurance, and preferred and non-preferred brand drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers a range of benefits with varying costs. Hospital stays have copays, and outpatient services have copays ranging from $0 to $300. Emergency and urgent care services have copays, while primary care has no copay for most services. Preventive services, eye exams, and eyewear have no copay, and the plan offers a combined maximum of $310 per year for eyewear. Dental services include copays and coinsurance for various procedures. The plan also covers home health services with no copay, and skilled nursing facility services with copays.
Inpatient Hospital See details
The Aetna Medicare Choice (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $400 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $375 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital Psychiatric are not covered, and non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Choice (PPO) plan, including all outpatient hospital services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $300 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a $40 copay, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, with a copay of $85.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Choice (PPO) plan. Ground Ambulance Services have a $250 copay, while Air Ambulance Services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Choice (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services and Individual and Group Sessions for Mental Health Specialty Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Physician Specialist Services have a copay between $0 and $40. Other Health Care Professional services have a copay between $0 and $40, while Opioid Treatment Program Services have a $30 copay. Additional Telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Psychiatric Services and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include several services with no copay, such as an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Other preventive services include additional sessions of smoking and tobacco cessation counseling, and fitness benefits, which also have no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered under the Aetna Medicare Choice (PPO) plan with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $500 per year, and inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Choice (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan offers a combined maximum of $310 per year for eyewear.
Dental Services See details
The Aetna Medicare Choice (PPO) plan covers Medicare dental services with a $30 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 by the Aetna Medicare Choice (PPO) plan. There is a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Choice (PPO) plan, including Durable Medical Equipment with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is also covered, with coinsurance for Medicare-covered therapeutic shoes or inserts and copays for Medicare-covered diabetes supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice (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 not covered by the Aetna Medicare Choice (PPO) plan. The plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Choice (PPO) plan, 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 stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with no copay, and Other 1 and Other 2 services with no copay. Acupuncture, Meal Benefit, 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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