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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 Select Northern and Richmond counties. This plan received an overall rating of 4.5 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 $85.00. 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 $1000.00 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 $7750.00 (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 $7750.00 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 a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, with a $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs will have 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Choice (PPO) plan provides comprehensive coverage with varying costs. Inpatient hospital stays have copays, while outpatient services and many preventive services have no copay. The plan also offers coverage for hearing, vision, and dental services, with specific copays and maximum benefit amounts for each. Emergency and ambulance services are covered with copays and coinsurance, while other services like home health and skilled nursing facilities have specific cost structures. The plan includes coverage for durable medical equipment, diagnostic services, and a range of therapies, along with additional benefits such as an over-the-counter allowance and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $374 copay for days 1-8, and no copay for days 9-90, while Inpatient Hospital Psychiatric has a $286 copay for days 1-8, and no copay for days 9-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while the additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric and upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay of $0-$374, observation services with a copay of $374, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a copay of $40 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Aetna Medicare Choice (PPO) covers partial hospitalization with a $105 copay. 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 $275 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, including Worldwide Emergency Services, are covered by the Aetna Medicare Choice (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $30 copay. The plan covers physician specialist services with a $50 copay, and mental health specialty services with a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and other health care professionals have a copay between $0 and $50. Psychiatric services, opioid treatment program services, and additional telehealth benefits are also covered with varying copays and a 20% coinsurance for telehealth.
Preventive Services See details
The Aetna Medicare Choice (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, each with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance and other preventive services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with a $50 copay, routine hearing exams with no copay for one visit per year, fitting and evaluation for hearing aids with no copay for one visit per year, and prescription hearing aids with a $500 maximum plan benefit per ear, every year with no copay for two visits per year for all types of hearing aids. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $50, while routine eye exams and other eye exam services have no copay. Eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, and a combined maximum benefit of $200 per year applies to both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Choice (PPO) plan covers various dental services. Medicare Dental Services have a $50 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1000 maximum plan benefit coverage amount per year for both in and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Choice (PPO) plan and require prior authorization, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Choice (PPO) plan, with a coinsurance between 20% and 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Choice (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20% with no copay. Diabetic Equipment is 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 $100, and Lab Services with no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific amount is not listed.
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 $180.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, a maximum plan benefit coverage amount of $45 every three months, and a meal benefit with no copay. Acupuncture, 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, 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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