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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 Connecticut. 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 $1250.00 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 Elite (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After you meet your deductible, you will pay the following costs for your drugs. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance, depending on the specific drug and pharmacy. After your total yearly drug costs reach $2000, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services can have copays ranging from $0 to $350. Emergency services have a $125 copay, and primary care visits cost $5. Preventive services such as annual physical exams, health education, and vision and dental services have no copay. The plan also includes coverage for hearing exams and hearing aids, as well as home health and skilled nursing facility services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $295 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, there is a $1937 copay.
Outpatient Services See details
Outpatient Services for Aetna Medicare Elite (PPO) includes coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Elite (PPO) plan. Emergency services have a $125 copay, urgently needed services have a $45 copay, worldwide emergency coverage and urgent coverage have a $125 copay, and worldwide emergency transportation has a $295 copay.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers Primary Care Physician Services with a $5 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $40 copay, Physician Specialist Services with a copay between $0 and $45, and Physical Therapy and Speech-Language Pathology Services with a $40 copay. The plan also covers Mental Health and Psychiatric Services, as well as Opioid Treatment Program Services, each with a $40 copay for individual or group sessions, and Additional Telehealth Benefits with a copay between $0 and $45 and 20% coinsurance. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Elite (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services for the Aetna Medicare Elite (PPO) plan include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum copay of $1700 for all types, 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
Vision Services includes coverage for eye exams with a copay between $0 and $45, and eyewear with no copay and a combined maximum benefit of $190 per year. Routine eye exams have no copay, while other eye exam services and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades also have no copay.
Dental Services See details
Aetna Medicare Elite (PPO) covers dental services, including oral exams, dental x-rays, and other diagnostic and preventative services with no copay, and also covers restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, up to a maximum of $500 per year. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Elite (PPO) plan. 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 Elite (PPO) plan, and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $45, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $175, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $10 copay.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but some services are not covered. The plan does not specify the copay or coinsurance for covered services.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Elite (PPO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Elite (PPO) plan's Other Services benefit covers meal benefits and other services, with no copay. Acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, 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.
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