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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 Clark and Nye 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 $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 $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 $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 has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12.00 copay at standard pharmacies. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 24% or 25% coinsurance.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, with acute care at $320 for days 1-5 and psychiatric care at $370 for days 1-5. Outpatient services have copays between $0 and $350, while primary care visits have no copay. Preventive services, including an annual physical exam, are covered with no copay, along with hearing exams, eyewear, and many dental services. The plan also covers home health services with no copay. The plan has a $105 allowance every three months for over-the-counter (OTC) items.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with prior authorization. For acute care, you'll pay a $320 copay for days 1-5 and no copay for days 6-90; for psychiatric care, you'll pay a $370 copay for days 1-5 and no copay for days 6-90. Additional days and upgrades for inpatient hospital acute and psychiatric care, as well as non-Medicare-covered stays, are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a copay of $320. 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 pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (PPO) plan, with prior authorization required. Ground ambulance services have a $335 copay, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. For Emergency Services, you will pay a $125 copay, and for Urgently Needed Services, you will pay a $35 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $335 copay; all of these services have no coinsurance.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, and physician specialist services with a copay between $0 and $30. The plan also covers mental health and psychiatric services and opioid treatment program services with a $40 copay for individual and group sessions, plus physical therapy and speech-language pathology services with a $20 copay. The plan also covers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
The Aetna Medicare Elite (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, all with no copay; however, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, or support for caregivers of enrollees. Kidney disease education services have a 20% coinsurance. Other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with 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 plan benefit coverage of $2,000 per year, per ear, but specific types such as inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Elite (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $355 every year for both in-network and out-of-network services.
Dental Services See details
Dental Services are covered and include a $30 copay for Medicare Dental Services. 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $2,200 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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. This plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance of 0% to 20%. Diabetic Supplies have a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $300.00. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no 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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Elite (PPO) plan, but the specific services are not covered. There is no copay or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan, with a copay of $10 for days 1-20, and a copay of $203 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Elite (PPO) plan's Other Services benefit covers over-the-counter (OTC) items with no copay, and provides a $105 allowance every three months. Acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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