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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 North Texas Non Metro counties. 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 $9550.00 (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 $9550.00 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. In the initial coverage phase, you'll pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies. For standard generic drugs, you'll pay 22% coinsurance, regardless of the pharmacy. For preferred brand and non-preferred drugs, you'll pay 25% coinsurance. 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 a wide range of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, while outpatient services include copays for specific services like substance abuse and observation services, with no copay for ambulatory surgical center services. The plan also covers ambulance services, emergency services, and primary care with no copay for many services, and also covers preventive services. Additional benefits include hearing, vision, and dental services, with no copays for eye exams, eyewear, oral exams, and dental x-rays. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance, and covers home health services with no copay. There are also benefits like OTC items with a quarterly allowance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Choice (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $445 copay for days 1-6 and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $325 copay 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 additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $275, observation services with a $315 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Outpatient blood services also include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, but requires prior authorization. You will pay a $85 copay 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 $280 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 under 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 $280 copay for Worldwide Emergency Transportation; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $30, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $30 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $55. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services, with some requiring a copay. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per ear every year, with no copay for prescription hearing aids (all types).
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 eyewear has a combined maximum of $225 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Choice (PPO) plan covers dental services, including oral exams with no copay, and dental x-rays and prophylaxis (cleaning) with no copay. Other services like 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 have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Choice (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20% and Prosthetics/Medical Supplies with a coinsurance for some services. Diabetic Equipment is also covered, with a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a copay for Medicare-covered Diabetes Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, Lab Services with no copay, and Diagnostic Radiological Services with a copay up to $325. Therapeutic Radiological Services have a coinsurance of at least 20%, 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, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan, but the specific services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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 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, and a maximum benefit of $30 every three months. Other services, including acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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