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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 Metro: LI, BX, BK, Queens, Westchester/Rockland. 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 a $590 deductible for prescription drugs. After the deductible is met, you will pay the following costs. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan provides coverage for a wide array of healthcare services. Inpatient hospital stays require prior authorization and cost $850 per admission. Outpatient services have varying copays, and emergency services have a $110 copay. This plan offers comprehensive coverage for primary care with no copays for many services, including annual physical exams. Hearing and vision services are covered, with copays for exams and coverage for eyewear. Dental services include no copays for some services, and other benefits include home health services with no copay and skilled nursing facility coverage with a $0 copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Elite (PPO) plan, with Inpatient Hospital-Acute services requiring a prior authorization and costing $850 per admission or stay. Inpatient Hospital Psychiatric services also require prior authorization and have a copay of $339 for days 1-6 and no copay for days 7-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $395 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 copay for both Individual and Group Sessions. Outpatient Blood Services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan and requires prior authorization. You will pay an $80 copay for this benefit.
Ambulance and Transportation Services See details
For Aetna Medicare Elite (PPO), ambulance services are covered with a $290 copay for both ground and air ambulance services, and no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $290 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay for routine care, and occupational therapy services with a $30 copay. This plan also covers physician specialist services with a copay between $0 and $35, and mental health services with a $40 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services such as health education and wigs for hair loss related to chemotherapy with no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing Exams have a $35 copay, while Routine Hearing Exams and Fitting/Evaluation for Hearing Aids have no copay. Prescription Hearing Aids (all types) have a maximum copay of $1,700, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. Over-the-counter hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams have a copay between $0 and $35, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $200 every year.
Dental Services See details
The Aetna Medicare Elite (PPO) plan covers Medicare dental services with a $35 copay, oral exams, dental X-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 Elite (PPO) plan, but prior authorization is required. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) subject to a coinsurance of 0-20%, and Durable Medical Equipment for use outside the home not covered. Prosthetics/Medical Supplies have a coinsurance, and Diabetic Equipment is covered with a coinsurance of 0-20% for Diabetic Supplies and 20% for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $35, and Lab Services with no copay. Outpatient X-Ray Services have a $35 copay, while Diagnostic Radiological Services have a copay up to $300. Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Elite (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 not in practice as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, SET for PAD Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for some services, but the specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, 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, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered. Other services include annual wellness exams, screening mammography, gFOBT, and FIT, all with no copay.
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