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Aetna Medicare Essential Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Essential 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 Essential Elite (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Essential Elite (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 2025.
It's important to know that Aetna Medicare Essential 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 Essential 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 Essential 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 $450.00 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 Essential Elite (PPO) plan has an "Enhanced Alternative" drug benefit. The plan has a $450 deductible for prescription drugs. After the deductible, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy, while you'll pay 22% coinsurance for standard generic drugs at either a preferred or standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Essential Elite (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have copays, while outpatient services like blood work and ambulatory surgical centers have no copay. You can expect copays for primary care, specialist visits, and therapies, but preventive services like annual physicals have no copay. The plan provides coverage for hearing and vision, including eye exams and eyewear, with no copay for many services. Dental services, including oral exams and cleanings, also have no copay, with a $1,000 annual maximum. The plan also covers ambulance services, emergency services, and home health services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage for the Aetna Medicare Essential Elite (PPO) plan includes Inpatient Hospital-Acute, with a $295 copay for days 1-6 and no copay for days 7-90, as well as Inpatient Hospital Psychiatric, with a $385 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $325, observation services with a $295 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Aetna Medicare Essential Elite (PPO) covers partial hospitalization with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $295 copay, while air ambulance services have a 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 by Aetna Medicare Essential Elite (PPO). Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $295 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Essential Elite (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $40 copay. Physician specialist services have a copay between $0 and $40, while mental health specialty services, psychiatric services, and opioid treatment program services each have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, and no copay for additional preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following the welcome visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types, but inner ear, outer ear, and over-the-ear aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Essential Elite (PPO) plan covers vision services, including eye exams with a copay of $0-$40, and eyewear with no copay. Eyewear has a combined maximum benefit of $320 per year, covering contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Essential Elite (PPO) plan covers 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. This plan does not cover maxillofacial prosthetics, implant services, or orthodontics. There is a $1,000 maximum plan benefit coverage per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Chemotherapy/Radiation Drugs, and other Medicare Part B Drugs. There is a $35 copay for Medicare Part B Insulin Drugs, and coinsurance applies for Chemotherapy/Radiation Drugs and other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Essential Elite (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment includes Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, while Diabetic Equipment has a coinsurance between 0% and 20% and a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Outpatient X-ray services have a $10 copay, while diagnostic radiological services have a copay of at most $175, and therapeutic radiological services have at most 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Essential Elite (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Essential Elite (PPO), but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for the services that are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Essential Elite (PPO) plan, but require prior authorization. For days 1-21, the copay is $10, and for days 22-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Essential Elite (PPO) plan's Other Services benefit includes a Meal Benefit with no copay. However, acupuncture, over-the-counter items, 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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