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Aetna Medicare Enhanced Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Enhanced Select (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Enhanced Select (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IN, MI, WI. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Enhanced Select (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 Enhanced Select (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 Enhanced Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $166.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $1500.00 (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 $1500.00 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 Enhanced Select (PPO) plan has a $590 deductible for prescription drugs. After meeting your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you'll pay $42.90. per month.
Additional Benefits
The Aetna Medicare Enhanced Select (PPO) plan offers a range of benefits with varying cost-sharing. You'll find coverage for inpatient hospital stays with a $200 copay for the first seven days, and no copay for outpatient services, primary care visits, preventive services, and many other services, including hearing and vision exams. The plan also includes coverage for dental services, home health, and durable medical equipment, with no copay. This plan includes cost-sharing for some services. Ambulance services have a $275 copay for ground transport, and emergency services have a $125 copay. Certain services have coinsurance, such as air ambulance, dialysis, and some diabetic supplies.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will also pay a $200 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0.00 - $200.00, and observation services have a copay of $200.00. Ambulatory surgical center services, individual outpatient substance abuse sessions, group outpatient substance abuse sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Enhanced Select (PPO) plan with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Enhanced Select (PPO) plan. Ground ambulance services have a $275 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 Enhanced Select (PPO). Emergency Services have a $125 copay, Urgently Needed Services have no copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency and Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Enhanced Select (PPO) plan covers primary care physician services, chiropractic services, physician specialist services, occupational therapy services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, opioid treatment program services, and additional telehealth benefits with no copay. Routine chiropractic care and podiatry services are not covered. Additional telehealth benefits have a 20% coinsurance.
Preventive Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a copay. Kidney disease education services are covered with 20% coinsurance, and other preventive services include no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $500 per year, per ear. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers vision services including eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum benefit of $175 per year.
Dental Services See details
Dental services are covered, with a $1,500 annual maximum benefit. You'll pay no copay for 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 by the Aetna Medicare Enhanced Select (PPO) plan. This plan requires prior authorization, and has a coinsurance of 20% 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 no copay and no coinsurance, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have no copay and 0% coinsurance. Diabetic supplies have a 0-20% coinsurance, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. Lab Services and Outpatient X-Ray Services have no copay, while Therapeutic Radiological Services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Enhanced Select (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Enhanced Select (PPO) plan. The plan does not cover any cardiac rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Enhanced Select (PPO) plan, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required, and more information about the copay is available in the plan details.
Other Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage of $30 every three months. Other services like acupuncture, meal benefits, and many others are not covered.
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