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Aetna Medicare Elite Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite Extra (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 Extra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite Extra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Connecticut. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite Extra (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 Extra (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 Extra (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 $1500.00 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 $6750.00 (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 $6750.00 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 Extra (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. If you choose a standard pharmacy or standard mail order, Tier 1 drugs carry a copay starting at $2, while Tier 2 drugs start at a $12 copay for a one-month supply. For higher-tier prescription drugs under this plan, cost-sharing transitions to coinsurance across all pharmacy and mail order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply equally whether you utilize preferred or standard pharmacies and mail order services.
Additional Benefits
The Aetna Medicare Elite Extra (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, while specialist visits require a copay of up to $55. For hospital stays, inpatient acute care incurs a $458 daily copay for the first six days and no copay thereafter, while outpatient services range from no copay to a $450 copay with no coinsurance. Emergency care is accessible with a $130 copay, which is waived if admitted, and urgent care has a $50 copay. Routine preventive care, annual physicals, and home health services are fully covered with no copays or coinsurance. Routine dental, vision, and hearing exams also feature no copays, though there is a $100 annual allowance for eyewear and hearing aid copays up to $1,700. Additionally, durable medical equipment features no copays with coinsurance ranging up to 25 percent.
Inpatient Hospital See details
Aetna Medicare Elite Extra (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required, and upgrades or non-Medicare-covered stays are not covered. For acute stays, there is a $458 daily copay for days 1 through 6 and no copay for day 7 and beyond, while psychiatric stays require a $390 daily copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
Outpatient services under the Aetna Medicare Elite Extra (PPO) are covered with no coinsurance, including ambulatory surgical center and blood services which also feature no copays. Outpatient hospital services require copays from $0 to $450, observation services have a $458 copay per stay, and outpatient substance abuse sessions carry a $55 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite Extra (PPO) with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Elite Extra (PPO), featuring a $320 copay (and no coinsurance) for ground ambulance services and a 20% coinsurance (and no copay) for air ambulance services. Prior authorization is required for ambulance services, while transportation services to health-related locations are not covered.
Emergency Services See details
Aetna Medicare Elite Extra (PPO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $130 to $320, up to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Elite Extra (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $55 copay and no coinsurance. Physical, occupational, mental health, and psychiatric services feature a $50 to $55 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Elite Extra (PPO), with most covered services—such as annual physicals, health education, and fitness benefits—carrying no copay and no coinsurance, though kidney disease education requires no copay and a 20% coinsurance. Sub-services that are not covered under this plan include weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, personal emergency response systems, in-home safety assessments, and nutritional, counseling, telemonitoring, or caregiver support services.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Elite Extra (PPO), offering annual routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $55 copay and no coinsurance. Prescription hearing aids are covered up to two per year with no coinsurance and copays up to $1,700, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite Extra (PPO) covers vision services with no deductible and no coinsurance, featuring eye exams with a $0 to $55 copay and eyewear with no copay. Routine eye exams are covered once per year with no copay, and there is a combined $100 annual maximum benefit for eyewear.
Dental Services See details
Aetna Medicare Elite Extra (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $55.00 copay and no coinsurance. While routine exams, cleanings, and X-rays are covered with no copay and no coinsurance, other services including fluoride, restorative work, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Elite Extra (PPO) with no copay, though prior authorization is required. Under this benefit, Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance and no copay.
Dialysis Services See details
Aetna Medicare Elite Extra (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for this covered benefit.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite Extra (PPO) with no copays for durable medical equipment (DME), prosthetics, medical supplies, and diabetic shoes. Coinsurance ranges from no coinsurance up to 25% for DME and medical supplies, is 25% for prosthetics, and ranges from no coinsurance up to 20% for diabetic supplies, with prior authorization required.
Diagnostic and Radiological Services See details
Aetna Medicare Elite Extra (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiological services with no copay or coinsurance. Diagnostic tests carry no coinsurance and a copay of $0 to $40, while radiological services require a $20 copay plus coinsurance for X-rays and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite Extra (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Elite Extra (PPO) with no coinsurance, meaning some services are covered, but specific sub-services including cardiac ($20 copay), intensive cardiac ($20 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Elite Extra (PPO) because additional days beyond the standard 100 days are not covered. Covered stays require prior authorization and no coinsurance, featuring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 with no prior three-day hospital stay required.
Other Services See details
Aetna Medicare Elite Extra (PPO) partially covers other services, offering no copay and no coinsurance for a chronic illness meal benefit, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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