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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 Maricopa, Pima and Pinal Counties. 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 $950.00 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) plan features a $615.00 prescription drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs at preferred pharmacies and preferred mail order, while standard pharmacies charge a $12.00 copay. For other tiers, you will pay a 24% coinsurance for standard generics and a 25% coinsurance for both preferred brand and non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescription drugs. Furthermore, beneficiaries who qualify for the low-income subsidy will see their Part D premium reduced to $0.00. This plan provides structured cost-sharing to help you easily anticipate your medication expenses.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs. You will pay no copay or coinsurance for primary care physician visits, routine preventive services, and home health care. For more intensive care, inpatient hospital stays require a daily copay of $400 for the first six days, while emergency room visits carry a $130 copay with no coinsurance. This plan also provides valuable supplemental benefits, including routine dental, vision, and hearing exams with no copay or coinsurance, subject to specific annual coverage limits. Diagnostic lab services and outpatient X-rays are fully covered with no copay, while other services like dialysis and medical equipment require up to a 20% coinsurance with no copay. Skilled nursing facility stays are also covered, offering no copay or coinsurance for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Aetna Medicare Elite (PPO), requiring a $400 daily copay for days 1-6 of acute care and a $370 daily copay for days 1-5 of psychiatric care, with no coinsurance and no copay for remaining covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Elite (PPO) with no coinsurance, offering no copay for ambulatory surgical center and blood services. Other outpatient services require copayments, ranging from a $35 copay for substance abuse sessions to a $400 copay per stay for observation services, and $0 to $375 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Aetna Medicare Elite (PPO) with a copay of either $55.00 or $145.00 and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) partially covers ambulance and transportation services, as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $320 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency services are also covered up to a $250,000 limit, featuring a $130 copay for emergency or urgent care and a $320 copay for emergency transportation, with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Aetna Medicare Elite (PPO), featuring no copay or coinsurance for primary care physician visits, while other services have copays ranging from $0 to $50 and up to 20% coinsurance. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (PPO), featuring no copay and no coinsurance for most covered benefits, except for kidney disease education which requires a 20% coinsurance and no copay. Uncovered services include in-home safety assessments, personal emergency response systems, 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 modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Elite (PPO), which offers routine exams, fitting evaluations, and select prescription hearing aids with no copay or coinsurance, up to a $1,000 annual limit. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers vision services with no copay and no coinsurance for routine eye exams and eyewear. The plan provides up to a $50 annual allowance for eye exams and a $150 annual maximum benefit for eyewear, including contacts and eyeglasses.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite (PPO), excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Covered preventive services, such as exams and cleanings, have no copay and no coinsurance, while Medicare-covered dental services require a $45 copay and no coinsurance. Other covered services, including restorative and endodontic care, are subject to a $1,000 annual limit and require 20% to 50% coinsurance with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Elite (PPO) with prior authorization required, offering Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation drugs, require no copay and have a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Elite (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers medical equipment, prosthetics, and diabetic supplies with coinsurance ranging from no coinsurance up to 20% and no copays. Prior authorization is required for these services, which include durable medical equipment, prosthetic devices, and diabetic therapeutic shoes.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services, which require prior authorization. Patients pay no copay or coinsurance for lab services, outpatient X-rays, and diagnostic tests, while diagnostic radiological services carry a copay of up to $195 with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Elite (PPO) plan, as none of the sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Aetna Medicare Elite (PPO), which does not cover additional days beyond the Medicare-covered limit. Covered stays require prior authorization and feature no copay or coinsurance for days 1 to 20, followed by a $218 daily copay and no coinsurance for days 21 to 100.
Other Services See details
Other Services are partially covered by Aetna Medicare Elite (PPO), which provides annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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