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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 2026, 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 Connecticut. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $1750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 Elite (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service for any supply length. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For higher-tier medications, costs transition to coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copays for primary care visits and copays up to $60 for specialist visits. For hospital care, members pay a daily copay of $458 for days one through six of acute inpatient stays, while outpatient hospital services range from no copay to a $450 copay. Emergency room visits require a $130 copay, which is waived if admitted within 24 hours, and urgent care has a $50 copay. Routine wellness services, annual physicals, and home health care are covered with no copay and no coinsurance. Routine dental cleanings, routine eye exams, and routine hearing evaluations also feature no copay, though Medicare-covered dental, vision, and hearing treatments require a $60 copay. Durable medical equipment and dialysis services are covered with no copays, requiring coinsurance up to 25% instead.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $458 daily copay for days 1 to 6 of acute stays and a $390 daily copay for days 1 to 6 of psychiatric stays, with no copay for remaining covered days. Prior authorization is required, and some services—including upgrades, non-Medicare-covered stays, and additional psychiatric days—are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $458 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $60 copay.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with no coinsurance, though prior authorization is required. Depending on the service, members will pay a copay of either $70.00 or $145.00.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Elite (PPO), with ground ambulance services requiring a $295 copay and air ambulance services requiring a 20% coinsurance, both of which require prior authorization. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered in practice.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 maximum benefit, featuring a $130 copay for emergency or urgent care, a $295 copay for emergency transportation, and no coinsurance.
Primary Care See details
Aetna Medicare Elite (PPO) primary care and specialist services are covered with copays ranging from no copay to $60 and no coinsurance, though podiatry and routine chiropractic services are not covered. Physical, occupational, mental health, and psychiatric therapies are covered with copays between $45 and $60 and no coinsurance, while telehealth services require a $0 to $60 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite (PPO) provides partially covered preventive services with no copay and no coinsurance for annual physical exams, health education, and glaucoma screenings, though kidney disease education requires a 20% coinsurance with no copay. Several supplemental services are not covered under this plan, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Elite (PPO), which features Medicare-covered exams for a $60 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $0 to $1,700, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (PPO) with no coinsurance, featuring routine eye exams with no copay and other eye exams with a copay up to $60. Covered eyewear, including contacts, eyeglasses, and upgrades, has no copay and no coinsurance up to a combined annual maximum of $125.
Dental Services See details
Aetna Medicare Elite (PPO) partially covers dental services, offering Medicare-covered dental with a $60.00 copay and no coinsurance, and select preventive services like cleanings, exams, and x-rays with no copay and no coinsurance. Fluoride, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite (PPO) with no copays, though prior authorization is required and coinsurance ranges from no coinsurance to 25% for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies carry no coinsurance to 20% coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under Aetna Medicare Elite (PPO) with prior authorization required, offering diagnostic services with no coinsurance, a $0 copay for lab work, and a $0 to $60 copay for diagnostic tests. Radiological services require a minimum 20% coinsurance for therapeutic treatments, a $20 copay plus coinsurance for outpatient X-rays, and a $0 minimum copay for diagnostic radiology.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Elite (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Elite (PPO) with no coinsurance, though some services are covered; however, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $10.00 daily copay for days 1 through 20 and a $218.00 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Aetna Medicare Elite (PPO) partially covers other services, offering a meal benefit for chronic illness, annual wellness exams, screening mammographies, and additional colorectal screenings (gFOBT and FIT) with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered.
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