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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 Across GA. This plan received an overall rating of 3.5 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 $225.00 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 prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options incur low copays, starting at $2.00 for Tier 1 and $12.00 for Tier 2 one-month supplies. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust coverage with predictable costs, featuring no copays for primary care visits, annual physicals, routine hearing and vision exams, and home health services. For specialized care, members pay low to moderate copayments, such as $0 to $55 for specialist visits and a daily copay of $407 for the first six days of inpatient hospital stays. Most outpatient, diagnostic, and emergency services require no coinsurance, keeping out-of-pocket costs manageable for common medical needs. Supplemental benefits include comprehensive dental coverage with no copays and a $2,000 annual limit, alongside a $200 yearly allowance for eyewear and up to $500 annually for prescription hearing aids. Essential medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance. Additionally, the plan provides extra perks like a quarterly over-the-counter allowance and chronic illness meals at no cost to the member.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $407 daily copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and 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 no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a copay of $0 to $450, observation services require a $407 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Elite (PPO) plan with a copay of $105.00 or $110.00 and no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Elite (PPO), requiring prior authorization and offering ground ambulance services for a $290 copay and no coinsurance, and air ambulance services for a 20% coinsurance and no copay. While transportation is technically covered, only some services are covered in practice, and transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under the Aetna Medicare Elite (PPO) plan are covered with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 lifetime maximum with no coinsurance and copays of $115 for emergency or urgent care and $290 for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Elite (PPO) offer primary care physician visits with no copay and no coinsurance, and specialist services with a $0 to $55 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays ranging from $35 to $50 and no coinsurance, while podiatry is not covered and chiropractic services are only partially covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (PPO), offering no copay and no coinsurance for annual physical exams, health education, and glaucoma screenings. While kidney disease education is covered with no copay and a 20% coinsurance, several supplemental benefits including weight management, nutritional/dietary benefits, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Elite (PPO), offering annual routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $55 copay and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual maximum, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services covered by the Aetna Medicare Elite (PPO) feature no coinsurance and no deductibles, with copays ranging from $0 to $55 for eye exams and no copay for eyewear. The plan includes one annual routine eye exam with no copay and provides a $200 yearly combined maximum allowance for eyeglasses, contacts, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (PPO), excluding fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services. Medicare-covered dental requires a $55 copay and no coinsurance, while covered preventive care has no copay or coinsurance, and comprehensive services require no copay and 20% to 50% coinsurance up to a $2,000 annual limit.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs are covered with no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Elite (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite (PPO) with no copay and up to 20% coinsurance for durable medical equipment (DME), medical supplies, and diabetic supplies. Prosthetic devices require no copay and 20% coinsurance, while diabetic therapeutic shoes and inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Elite (PPO), offering no copay for lab services and outpatient X-rays, and a $0 to $95 copay with no coinsurance for diagnostic tests. Diagnostic radiological services start at no copay, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorization required for most services.
Home Health Services See details
Aetna Medicare Elite (PPO) covers home health services with no copay and no coinsurance, although 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 in practice. Under this benefit, standard cardiac rehabilitation ($25 copay), intensive cardiac rehabilitation ($25 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring prior authorization and 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 standard 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 meals, annual wellness exams, and a $15 quarterly over-the-counter reimbursement. Acupuncture is not covered under this benefit.
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