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Aetna Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Choice (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Ventura County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice (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 Choice (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 Choice (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $84.00. 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 $250.00 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 $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 Choice (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you will pay no copay at preferred pharmacies or through preferred mail order, and a $12 copay at standard pharmacies or through standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance, depending on the drug tier.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $395 copay for the first five days, with no copay for subsequent days. Outpatient services and primary care visits have no copay, while other services like specialist visits, therapy, and emergency services have copays ranging from $10 to $125. Preventive services, including an annual physical exam, and vision services have no copay. Dental services are available with no copay for most services, and a $40 copay for Medicare dental services, up to a maximum benefit of $1250 per year. The plan also covers hearing exams and hearing aids, also with no copay, and a maximum benefit of $1250 per year.
Inpatient Hospital See details
The Aetna Medicare Choice (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a $395 copay for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and Inpatient Hospital Psychiatric additional days and non-Medicare-covered stays are also not covered.
Outpatient Services See details
The Aetna Medicare Choice (PPO) plan covers outpatient hospital services with a copay between $0 and $350, observation services with a $395 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay of $40 for both individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, but requires prior authorization. You will pay a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Choice (PPO) plan. Ground ambulance services have a $300 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 Choice (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency and Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services are covered with a $10 copay, but routine care is not covered. Occupational Therapy Services, Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services each have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40. Other Health Care Professional services have a copay between $0 and $35. Physician Specialist Services have a copay between $0 and $35. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
The Aetna Medicare Choice (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, or Support for Caregivers of Enrollees. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services with the Aetna Medicare Choice (PPO) plan includes hearing exams and fitting/evaluation for hearing aids with no copay, and routine hearing exams with no copay for one visit per year, as well as prescription hearing aids with a maximum benefit of $1250 per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Aetna Medicare Choice (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay. A combined maximum of $75 per year applies to eyewear.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, while other services like Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery have no copay; however, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. This plan has a maximum benefit of $1250 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Choice (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. For durable medical equipment, you may pay between 0% and 20% coinsurance, and for medical supplies, you may pay between 0% and 20% coinsurance. For diabetic therapeutic shoes/inserts, there is no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Choice (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $40, and lab services with no copay. Radiological services are covered with a copay of up to $295 for diagnostic services and a 20% coinsurance for therapeutic services, while outpatient X-rays have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice (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 by the Aetna Medicare Choice (PPO) plan. However, specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
The Aetna Medicare Choice (PPO) plan covers Skilled Nursing Facility (SNF) services with prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $150 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Choice (PPO) plan covers over-the-counter items with no copay, but the maximum plan benefit is $30 every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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