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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 Washoe County. 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) prescription drug coverage includes an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail-order options, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. For brand-name and specialty drugs, this plan charges a percentage of the drug cost rather than a flat copay. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy options. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a $40 copay for specialists and mental health visits, while inpatient hospital stays require a $385 daily copay for the first six days before transitioning to no copay. Outpatient services generally feature no coinsurance, with copays ranging up to $325 depending on the specific hospital service. This plan also provides strong supplemental benefits, including no copays or coinsurance for routine dental, vision, and hearing exams. Members receive annual allowances of up to $250 for eyewear and $1,000 per ear for hearing aids, alongside comprehensive dental coverage up to a $2,000 yearly limit with 20% to 50% coinsurance. Additionally, the plan covers durable medical equipment with no copays and up to 20% coinsurance, plus an over-the-counter allowance of $50 every three months.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) covers inpatient acute hospital stays with no coinsurance and a $385 daily copay for days 1-6 (no copay for days 7 and beyond), and psychiatric stays with a $370 daily copay for days 1-5 (no copay for days 6-90). Prior authorization is required, and upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services under Aetna Medicare Elite (PPO) are covered with no coinsurance, including no copay for ambulatory surgical center and blood services. Patients will pay a $40 copay for outpatient substance abuse sessions, a $385 copay per stay for observation services, and a copay of up to $325 (with some services having no copay) for outpatient hospital services.
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, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ground ambulance services with a $315 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. 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, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum limit with no coinsurance and copays ranging from $130 to $315.
Primary Care See details
Aetna Medicare Elite (PPO) covers primary care doctor visits with no copay and no coinsurance, and specialist, mental health, and psychiatric services with a $40 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay and no coinsurance, while chiropractic services are partially covered (routine and other chiropractic services are not covered) and podiatry is not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Elite (PPO) with no copay and no coinsurance for annual physicals, screenings, and fitness benefits, though kidney disease education requires no copay and a 20% coinsurance. Sub-services that are not covered include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Elite (PPO) provides hearing services with no copay and no coinsurance for Medicare-covered exams, annual routine exams, and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 annual maximum benefit per ear, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year up to a $50 maximum benefit. Eyewear is also covered with no copay or coinsurance, offering a combined annual maximum benefit of $250 for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Elite (PPO) covers preventive dental services like exams, cleanings, and x-rays with no copay and no coinsurance, while Medicare-covered dental services require a $40 copay and no coinsurance. Comprehensive dental services, such as endodontics, periodontics, and prosthodontics, are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual limit. However, some services are not covered, including fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Aetna Medicare Elite (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers durable medical equipment (DME) and medical supplies with no copays and coinsurance ranging from no coinsurance to 20%. Medicare-covered prosthetic devices carry a 20% coinsurance with no copay, and diabetic therapeutic shoes and inserts are covered with no copay, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic procedures, lab services, and diagnostic radiological services with no copay and no coinsurance. Outpatient X-rays have no copay but require coinsurance, while therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
The Aetna Medicare Elite (PPO) plan covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Elite (PPO) with no coinsurance, but some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
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 three-day prior inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Elite (PPO) offers partial coverage for other services with no copay and no coinsurance for covered benefits, including an annual wellness exam, additional colorectal cancer screenings, and up to $50 every three months for over-the-counter items. Acupuncture and meal benefits are not covered.
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