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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 2025, 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 Capital Region and Hudson Valley Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $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 $14000.00 (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 $14000.00 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 has an enhanced alternative drug benefit. Before your coverage begins, you must pay a $590 deductible. Once your deductible is met, you will pay a $0 copay for preferred generic drugs at preferred and mail-order pharmacies, and $12 at standard pharmacies. Standard generic drugs have a 24% coinsurance, and preferred brands and non-preferred drugs have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a wide range of benefits with varying cost-sharing. You can expect no copays for services like primary care, preventive services, routine hearing exams, eyewear, and many dental services. The plan includes copays for outpatient services, ambulance services, emergency services, and specialist visits, with some services subject to coinsurance, such as dialysis, medical equipment, and therapeutic radiological services. This plan covers inpatient and outpatient hospital services, with copays applying. It also provides coverage for hearing, vision, and dental services, with specific copays or no copays for certain services. Additionally, the plan includes coverage for home health services with no copay, and covers home infusion bundled services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $850 copay per admission for Inpatient Hospital-Acute and a $339 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, but 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, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $350, while Observation Services have a $350 copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan, but requires prior authorization. You will have an $80 copay for this service.
Ambulance and Transportation Services See details
The Aetna Medicare Elite (PPO) plan covers ambulance services with a $300 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the Aetna Medicare Elite (PPO) plan. Emergency Services have a $110 copay and no coinsurance, and Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, while Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy, physical therapy, and speech-language pathology services have a $35 copay. The plan also covers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $45, and mental health and psychiatric services with a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, plus additional preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1250 per ear annually, and all types of prescription hearing aids have no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Elite (PPO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, and there is a combined maximum plan benefit coverage of $230 per year for eyewear.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $40 copay, along with other services with a $1,500 annual maximum. 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, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Chemotherapy/Radiation Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan, but require prior authorization. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits under the Aetna Medicare Elite (PPO) plan include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetics/Medical Supplies with a coinsurance for specific items, and Diabetic Equipment, also with coinsurance for covered supplies and shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (PPO) plan covers diagnostic and radiological services, including all diagnostic services, diagnostic procedures/tests with a copay between $0 and $40, and lab services with no copay. Outpatient X-Ray services have a $40 copay, while therapeutic radiological services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (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 Elite (PPO) plan, but specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and others are not covered. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (PPO), with a $0 copay for days 1-20, and a $185 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include a meal benefit with no copay, while acupuncture, over-the-counter items, 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 for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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. Other 1 and Other 2 services are covered with no copay.
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