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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 Coconino, Mohave and Yavapai Counties. 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 $500.00 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 $8900.00 (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 $8900.00 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 you meet your deductible, your cost-sharing will vary depending on the drug tier and the pharmacy you use. For example, you'll have no copay for preferred generic drugs at preferred pharmacies and preferred mail-order pharmacies. For standard generic drugs, you'll pay 24% coinsurance, while preferred and non-preferred brand drugs have 25% coinsurance. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase, where you'll pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like primary care and preventive services have no copay. The plan also covers hearing, vision, and dental services, with copays for some services and maximum annual benefits for hearing aids and eyewear. Additional benefits include coverage for ambulance, emergency, and home health services, as well as skilled nursing facility care. Diagnostic and radiological services have copays or coinsurance, and medical equipment has coinsurance. Some services, such as home infusion, dialysis, and cardiac rehabilitation, are covered with copays or coinsurance, while others have no cost.
Inpatient Hospital See details
The Aetna Medicare Elite (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $335 for days 1-5 and no copay for days 6-90 for acute care; inpatient psychiatric care has a $370 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay, while 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 are covered by Aetna Medicare Elite (PPO), including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $275, observation services have a $335 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $40 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Elite (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Elite (PPO), including both ground and air ambulance services. Ground ambulance services have a $255 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Urgent Coverage has a $125 copay, Worldwide Emergency Transportation has a $255 copay, and Urgently Needed Services have a $50 copay; all have no coinsurance.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (excluding routine care), Occupational Therapy Services with a $25 copay, and Physician Specialist Services with a $0-$35 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services each have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits have a 20% coinsurance and a $0-$50 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services including Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit with no copay. Kidney Disease Education Services has a 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with a maximum benefit of $1250 per year, per ear, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay. Routine eye exams are limited to one per year. Eyewear has a combined maximum benefit of $150 every year.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $35 copay, and other services like oral exams, dental x-rays, and cleaning with no copay, up to a $2,000 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Elite (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 0-20% coinsurance, 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 under the Aetna Medicare Elite (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $10, Lab Services have no copay, and Outpatient X-Ray Services have a $10 copay; Diagnostic Radiological Services have a copay up to $250, and 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; however, 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 the sub-services are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Elite (PPO) plan covers over-the-counter (OTC) items with no copay and covers "Other 1" and "Other 2" services with no copay. Acupuncture, meal benefits, 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.
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