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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 Salt Lake Metro and Southern Utah. 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 $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 Choice (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll have no copay at preferred pharmacies and no copay with preferred mail order. For standard generic drugs, you'll pay 24% coinsurance, regardless of the pharmacy. Brand name and non-preferred drugs have a 25% coinsurance.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay for the first five days, and outpatient services with varying copays. You'll find coverage for emergency services, primary care with no copay for many services, and preventive services with no copay for Medicare-covered services. The plan also covers hearing exams, vision services including eye exams and eyewear, and dental services with no copay for many services, up to a yearly maximum. Additional benefits include home health services with no copay, and coverage for durable medical equipment and home infusion services.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Aetna Medicare Choice (PPO) plan. For Inpatient Hospital-Acute, you will pay a $350 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; Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and outpatient substance abuse services. Outpatient hospital services have a copay between $0 and $295, observation services have a $350 copay, and individual and group outpatient substance abuse sessions have a $40 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $240 copay, and air ambulance services have 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. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $45 copay and no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay with no coinsurance, while Worldwide Emergency Transportation has a $240 copay with no coinsurance.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, and specialist services with a copay between $0 and $20. Mental health and psychiatric services have a $40 copay for individual or group sessions. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and annual physical exams with no copay. Additional preventive services may include copays for certain services. Kidney Disease Education Services has a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $1250 per ear, every year. However, prescription hearing aids for the inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year, while other eye exam services are unlimited. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, has no copay and a combined maximum plan benefit of $250 per year.
Dental Services See details
The Aetna Medicare Choice (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, fluoride treatment, and other preventive services with no copay, and restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but it does not cover maxillofacial prosthetics, implant services, or orthodontics. This plan has a maximum benefit of $1,000 per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Choice (PPO) with a coinsurance between 20% and 20%. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a coinsurance between 0% and 20%, and prosthetic devices with a 20% coinsurance. Diabetic equipment is also covered, with a coinsurance between 0% and 20% for diabetic supplies, and no copay for diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Diagnostic Procedures/Tests and Lab Services have no copay, and Diagnostic Radiological Services have a copay of up to $250.00. 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, though additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan, but the specific services are not covered. The plan does not specify any copay or coinsurance costs for these services.
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 $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Choice (PPO) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $45.00 every three months. Acupuncture, meal benefits, and several other services are not covered.
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