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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 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 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 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 $10000.00 (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 $10000.00 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 you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For the Initial Coverage Phase, you will pay no copay for preferred generic drugs at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. You will pay 24% coinsurance for standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. After your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient hospital stays with a copay, outpatient services with copays varying between $0 and $275, and emergency services with copays ranging from $45 to $125. Primary care, preventive, hearing, vision, and dental services are also covered, often with no copay, but with an annual maximum benefit for dental and eyewear. Additional benefits of this plan include coverage for ambulance, home infusion, dialysis, and medical equipment with varying copays and coinsurance. Diagnostic, radiological, home health, and cardiac rehabilitation services are covered, as well as skilled nursing facility stays with a copay after the first 20 days. The plan also covers OTC items and other services, with some services not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. 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 all outpatient hospital services with a copay between $0 and $275, observation services with a $275 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Choice (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Choice (PPO) plan. Ground Ambulance Services have a $310 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $310 copay; there is no coinsurance for any of these services.
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 has a $20 copay, and physical therapy and speech-language pathology services have a $20 copay as well. The plan also covers physician specialist services with a copay between $0 and $40, and mental health specialty services and psychiatric services with a $40 copay for individual and group sessions. Other health care professionals are covered with a copay between $0 and $40. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional services with varying copays. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a plan-specified amount of $1250 per ear every year, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Choice (PPO) plan covers vision services, including eye exams and eyewear. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. Eyewear has a combined maximum plan benefit coverage of $260 per year.
Dental Services See details
Dental services are covered with a $45 copay for Medicare dental services, and a maximum benefit of $1500 per year. 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 are covered with no copay. 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 with prior authorization. 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. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits are covered by Aetna Medicare Choice (PPO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is also covered, with a coinsurance for Medicare-covered diabetic shoes or inserts, and a copay for Medicare-covered diabetes supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic and radiological services. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay information is listed below.
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, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Other 1 and Other 2 benefits, with no copay for OTC Items, annual wellness exams, screening mammography, gFOBT, and FIT. Acupuncture, meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services, Services in an Intermediate Care Facility, 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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