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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 Davis, Salt Lake and Utah Counties. 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 $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 $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 $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 Elite (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs carry a copay of $2 to $6, while Tier 2 drugs require a copay ranging from $12 to $36 depending on the supply duration. For higher-tier medications, costs shift to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brands require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. Note that Tier 5 specialty drugs are limited to a one-month supply under this plan.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, routine physicals, and home health services. Members also enjoy no copays or coinsurance for routine hearing exams, vision exams, and preventive dental care, though annual dollar limits apply to hardware like hearing aids and eyewear. Specialist visits and diagnostic services like lab tests and X-rays are also highly affordable, often requiring no copay or a low copay with no coinsurance. For more intensive medical needs, inpatient hospital stays and skilled nursing facility care require daily copays for the initial days of a stay but transition to no copay for subsequent days. Emergency care is covered with a flat copay that is waived upon admission, while outpatient surgeries and diagnostic procedures generally feature no coinsurance and predictable copays. Durable medical equipment and dialysis services are also covered with no copay but may require up to a twenty percent coinsurance.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $425 for days 1 through 6 of acute stays and $370 for days 1 through 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and some services like 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 $400 copay for outpatient hospital services and a $425 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $40 copay per session with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with a copayment of either $55.00 or $145.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ambulance services with prior authorization, requiring a $280 copay and no coinsurance for ground services, and a 20% coinsurance with no copay for air services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $130 to $280.
Primary Care See details
Aetna Medicare Elite (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Physical, occupational, speech, mental health, psychiatric, and opioid treatment services are covered with a $40 copay and no coinsurance, while telehealth benefits carry a $0 to $50 copay and 20% coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Elite (PPO) provides partial coverage for preventive services, offering annual physical exams, health education, and memory fitness with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while other services such as in-home support, nutritional benefits, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Elite (PPO) offers partially covered hearing services with no copay and no coinsurance for routine exams, fitting evaluations, and prescription hearing aids. Up to $1,000 per ear is covered annually for prescription hearing aids, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers routine eye exams and eyewear with no copay, no coinsurance, and no deductible. The plan provides up to a $50 annual maximum for eye exams and a $200 annual combined limit for eyewear, including contacts, frames, and lenses.
Dental Services See details
Aetna Medicare Elite (PPO) offers partially covered dental services, excluding other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $40 copay and no coinsurance, while covered preventive services have no copay and no coinsurance. Covered comprehensive services have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (PPO) with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a coinsurance between 0% and 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
Aetna Medicare Elite (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays for all covered items. Coinsurance ranges from no coinsurance to 20% depending on the equipment, prior authorization is required, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Elite (PPO) plan, with prior authorization required for all services. Members pay no copay and no coinsurance for lab services, diagnostic procedures, diagnostic radiology, and outpatient X-rays, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Elite (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Elite (PPO) plan with no coinsurance, but some services are not covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services are not covered and require a $20 copay, while pulmonary rehabilitation is not covered and requires a $15 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite (PPO) partially covers other services, offering no copay and no coinsurance for over-the-counter items up to fifty dollars every three months via reimbursement, annual wellness exams, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
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