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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 Dallas and Surrounding 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 $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:
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, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy you use. For example, Preferred Generic drugs have no copay at preferred pharmacies and preferred mail order, but have 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 tier. After your total drug costs reach $2000, you will 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 cost-sharing. Inpatient hospital stays have a copay, but outpatient services often have no copay. Emergency and primary care services have copays, while preventive services, like an annual physical, have no copay. This plan also includes coverage for hearing, vision, and dental services. Hearing exams and eyewear have no copay, and dental services have copays for specific services. The plan also covers home health, diagnostic services, and medical equipment, with different copays and coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $425 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 Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered, with a copay of $325 for days 1-6 and no copay for days 7-90, but Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Choice (PPO) plan, including all outpatient hospital services, with copays ranging from $0 to $325. Observation Services have a $335 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, but requires prior authorization. You will pay a $70 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 $300 copay, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations 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 has a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational Therapy Services have a $30 copay, and Physical Therapy and Speech-Language Pathology Services have a $45 copay. Physician Specialist Services have a copay between $0 and $45, and Mental Health Specialty Services have a $45 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $55. Psychiatric Services, and Opioid Treatment Program Services have a $45 copay for individual and group sessions. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Choice (PPO) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services like health education, wigs for hair loss related to chemotherapy, and fitness benefits also with no copay. Kidney Disease Education Services has a 20% coinsurance. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a $500 maximum benefit per year, and Prescription Hearing Aids (all types) with no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and 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 eyewear has a combined maximum benefit of $235 per year.
Dental Services See details
The Aetna Medicare Choice (PPO) plan covers dental services, with a $40 copay for Medicare dental services and no copay for oral exams, dental x-rays, and cleanings, which are limited to 4, 3, and 2 visits per year respectively. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%, while prosthodontics (removable) and prosthodontics (fixed) have a 50% coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while 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 the Aetna Medicare Choice (PPO) plan with a coinsurance between 20% and 20%. Prior authorization is required for coverage.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Choice (PPO) plan, with no copay for Durable Medical Equipment (DME) and a coinsurance between 0% and 20%. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a coinsurance between 0% and 20%. 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, with a minimum copay of $0 and a maximum copay of $50 for Diagnostic Procedures/Tests, no copay for Lab Services, and a maximum copay of $375 for Diagnostic Radiological Services. Therapeutic Radiological Services have a minimum coinsurance of 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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services. There is a copay for the services, but the specific amount is not provided.
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.
Other Services See details
The Aetna Medicare Choice (PPO) plan does not cover acupuncture, over-the-counter items, or meal benefits. Other services, including annual wellness exams, screening mammography, and gFOBT/FIT, are covered with no copay.
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