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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 Cochise, Gila and Santa Cruz 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. Once you meet your deductible, you will pay the following costs for your drugs. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for your Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. The plan also offers benefits for vision, hearing, and dental services, with no copays for eye exams, hearing exams, and many dental services. Prescription hearing aids are covered up to $1250 per ear every year. This plan also provides coverage for primary care, preventive services with no copays, and home health services. Other key benefits include coverage for ambulance services, medical equipment, and diagnostic services. Additionally, the plan includes coverage for home infusion services and dialysis services.
Inpatient Hospital See details
The Aetna Medicare Elite (PPO) plan covers Inpatient Hospital services, with a copay of $335 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $370 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $275, observation services with a $335 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual or group sessions, and outpatient blood services with no copay. This plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan, but requires prior authorization. This benefit has a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $255 copay, and air ambulance services with 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. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $50 copay, and Worldwide Emergency Transportation has a $255 copay; all 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 $35 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $35 copay. The plan also includes additional telehealth benefits with a 20% coinsurance and a copay between $0 and $50. Mental health and psychiatric services, and opioid treatment program services have a $40 copay, and routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services includes coverage for Medicare-covered preventive services, with no copay, and an annual physical exam with no copay. Other preventive services, such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are also covered with no copay. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $1250 per ear every year, and all types of prescription hearing aids are covered with no copay.
Vision Services See details
Vision services include eye exams and eyewear. There is no copay for eye exams, including routine eye exams, and other eye exam services. Eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $200 every year.
Dental Services See details
The Aetna Medicare Elite (PPO) plan covers Medicare Dental Services with a $35 copay, and other dental services, including 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 with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,000 maximum benefit per year for both in 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, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0% to 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and a copay for Medicare-covered diagnostic and therapeutic radiological services. Outpatient X-ray services have a $10 copay, while therapeutic radiological services have a 20% coinsurance, and diagnostic radiological services have a copay of at most $250.
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 generally covered, but the plan does not cover any of the listed services. There is a copay for some services, but the details are not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $200 per day; additional days beyond Medicare coverage and non-Medicare-covered stays 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, as well as "Other 1" and "Other 2" services with no copay. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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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