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Aetna Medicare Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Select (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Select (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Select (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 Select (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 Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.00. 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 $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $8950.00 (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 $8950.00 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 Select (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you pay the deductible, you will pay a copay or coinsurance for your drugs depending on the tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies or through mail order, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2000.00, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Select (PPO) plan offers coverage for a variety of services with varying costs. This plan includes no copay for primary care, preventive services, hearing exams, vision exams and eyewear, and many dental services. The plan provides coverage for inpatient hospital stays, outpatient services, ambulance and emergency services, and home health services. This plan has copays for some services, such as outpatient substance abuse services, partial hospitalization, chiropractic services, and specialist physician services. It also has coinsurance for services like air ambulance, dialysis services, and some medical equipment. Additionally, the plan offers an OTC benefit and covers prescription hearing aids and wigs for hair loss related to chemotherapy.
Inpatient Hospital See details
The Aetna Medicare Select (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you pay a $290 copay for days 1-5 and no copay for days 6-90; Additional Days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5 and no copay for days 6-90; additional days and non-Medicare-covered stays for either service are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and ambulatory surgical center (ASC) services. Outpatient Hospital Services have a copay between $0 and $290, Observation Services have a $290 copay, and ASC Services have no copay. Outpatient Substance Abuse Services have a copay of $40 for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Select (PPO) with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Select (PPO) plan. Ground ambulance services have a $325 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 Select (PPO) plan. Emergency Services has a $125 copay, while Urgently Needed Services has a $35 copay, and both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, while Worldwide Emergency Transportation has a $325 copay and no coinsurance.
Primary Care See details
The Aetna Medicare Select (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $35, mental health specialty services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. The plan also covers other health care professional services with a copay between $0 and $35, psychiatric services with a $40 copay for individual and group sessions, and opioid treatment program services with a $40 copay. Additional telehealth benefits are covered with a coinsurance of 20% and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and other preventive services with no copay for services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. This plan also covers Wigs for Hair Loss Related to Chemotherapy with no copay, up to a maximum of $400 per year. Kidney Disease Education Services are covered with a 20% coinsurance.
Hearing Services See details
The Aetna Medicare Select (PPO) plan covers hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $1250 per ear every year with no copay, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, including routine eye exams and other eye exam services, and no copay for eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $275 per year.
Dental Services See details
The Aetna Medicare Select (PPO) plan covers Medicare dental services with a $35 copay and other dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1000 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Select (PPO) plan, with prior authorization required. 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 under the Aetna Medicare Select (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Select (PPO) plan covers Durable Medical Equipment with a coinsurance between 0% and 20% and requires prior authorization, but does not cover Durable Medical Equipment for use outside the home. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have no copay, while Diabetic Supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $225, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Select (PPO) with no copay and no coinsurance; however, 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 Select (PPO) plan. This includes 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 the Aetna Medicare Select (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $50.
Other Services See details
The Aetna Medicare Select (PPO) plan's "Other Services" benefit covers over-the-counter (OTC) items with no copay up to a maximum of $50 every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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