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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 Clark and Nye 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 $9550.00 (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 $9550.00 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 generic and Tier 2 generic drugs, you will pay no copay for one-month, two-month, or three-month supplies when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order services, Tier 1 copays start at $2 and Tier 2 copays start at $12. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance. This coinsurance rate remains the same whether you use preferred or standard pharmacies and mail-order options.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust core medical coverage with no copay and no coinsurance for primary care doctor visits, while specialist visits require a $30 copay. Inpatient hospital stays feature no coinsurance but require a daily copay of $320 for days 1 to 5 of acute stays, followed by no copay for days 6 through 90. Emergency care is available with a $130 copay, and urgent care visits require a $35 copay, with no coinsurance for either service. Many essential wellness benefits, including routine vision exams, hearing exams, and preventive dental care, are covered with no copay or coinsurance. Comprehensive dental services are covered up to a $2,000 annual limit with 20% to 50% coinsurance, and prescription hearing aids are covered up to $1,000 per ear with no copay. Additionally, the plan features no-copay home health services and a $60 quarterly over-the-counter benefit reimbursement.
Inpatient Hospital See details
Inpatient hospital care is covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring prior authorization and a daily copay of $320 for days 1 to 5 of acute stays and $370 for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. Unlimited additional acute days are covered at no copay, but upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, featuring a copay of $0 to $375 for outpatient hospital services and $320 per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with a copay of either $55.00 or $145.00 and no coinsurance, depending on the service. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ground ambulance services with a $315 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. While transportation services are technically covered, transportation to plan-approved or any other health-related locations is not covered by 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, and urgent care with a $35 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 limit with no coinsurance and copays of $130 for medical care and $315 for emergency transportation.
Primary Care See details
Primary care services under the Aetna Medicare Elite (PPO) feature no copay and no coinsurance for primary care doctor visits, while specialist visits require a $30 copay and no coinsurance. Therapy services, including physical, occupational, and speech, have a $20 copay and no coinsurance, whereas mental health, psychiatric, and opioid treatment sessions carry a $40 copay with no coinsurance. Podiatry and chiropractic services are not covered under this plan, but telehealth is available with a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite (PPO) offers partial coverage for preventive services, featuring an annual physical exam, glaucoma screenings, and select wellness benefits with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several supplemental services like in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Aetna Medicare Elite (PPO) provides partially covered hearing services, including routine hearing exams, fittings, and Medicare-covered exams with no copay, coinsurance, or deductible. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, though 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 vision services with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. Covered benefits include one routine eye exam per year (up to a $50 annual maximum) and a combined $250 annual allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Elite (PPO), offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental with a $30 copay and no coinsurance. Comprehensive dental benefits require no copay and 20% to 50% coinsurance up to a $2,000 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance of 0% to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers medical equipment with prior authorization required, offering no copay for durable medical equipment (DME), prosthetics, medical supplies, and diabetic shoes. Coinsurance ranges from no coinsurance to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices require a 20% coinsurance. Diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services, offering no copay and no coinsurance for diagnostic tests, lab services, and diagnostic radiological services. Outpatient X-rays have no copay but require coinsurance, while therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required for these benefits.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Elite (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Elite (PPO) plan, as all key sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered. While the plan features no coinsurance, these non-covered sub-services require copayments ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100 days 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 $60 every three months via reimbursement), annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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