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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 San Luis Obispo County. 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 $24.00. 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 $250.00 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 $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 has an enhanced alternative drug benefit. Before your coverage begins, you must first satisfy a deductible of $590. In the initial coverage phase, you pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy used. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the drug tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $295. Emergency and urgent care services have copays, and ambulance services have a copay or coinsurance. The plan covers primary care, specialist visits, and mental health services with copays. Preventive services are generally covered with no copay. Hearing and vision services have no copay, but have limits on coverage. Dental services are covered with no copay, up to a $1,000 annual limit. Durable medical equipment and home health services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital coverage for Aetna Medicare Elite (PPO) includes a $325 copay for days 1-4, and no copay for days 5-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered under the Aetna Medicare Elite (PPO) plan, including all outpatient hospital services, with a copay ranging from $0 to $295 for outpatient hospital services and a $325 copay for observation services. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization benefits are covered under the Aetna Medicare Elite (PPO) plan. There is a $70 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (PPO) plan. Ground Ambulance Services have a $285 copay, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Elite (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $40 copay, and Worldwide Emergency Services has a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $285 for Worldwide Emergency Transportation. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with no copay, and also covers chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, while physical therapy and speech-language pathology services have a $30 copay with no coinsurance. Physician specialist services have a copay between $0 and $25. Mental health and psychiatric services, as well as opioid treatment program services, have a $40 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and additional preventive services, such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and wigs for hair loss related to chemotherapy, some of which have a $0 copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay; prescription hearing aids (all types) are covered, with a maximum benefit of $1250 per ear every year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered with no copay. Routine eye exams are limited to one per year, and eyewear has a combined maximum benefit of $75 per year.
Dental Services See details
The Aetna Medicare 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. Medicare Dental Services have a $40 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,000 maximum plan benefit coverage amount for both in-network and out-of-network services every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with a 0% to 20% coinsurance, and prosthetics, medical supplies, and diabetic equipment with varying cost-sharing. Durable Medical Equipment for use outside the home is not covered, and diabetic supplies and services are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and may require prior authorization. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare 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 the Aetna Medicare Elite (PPO) plan, but the specific services listed are not covered. There is a copay for some services, but the exact amount is not specified.
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, the copay is $10 per day, and for days 21-100, the copay is $130 per day; additional days beyond Medicare-covered SNF stays, and non-Medicare-covered SNF stays, are not covered.
Other Services See details
The Aetna Medicare Elite (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $30.00 every three months. Acupuncture, meal benefits, 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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