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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 Tidewater and Surrounding Area. 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 $500.00 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 $7900.00 (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 $7900.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will enjoy no copay for any supply length when using a preferred pharmacy or preferred mail order. If you use standard pharmacies or standard mail order, copays start at $2 for Tier 1 and $12 for Tier 2. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy options. Specialty medications in Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers comprehensive medical coverage with predictable cost-sharing options. Beneficiaries enjoy no copay for primary care visits, routine physicals, and home health services, while specialist visits range from no copay to a $55 copay. For inpatient hospital stays, there is no coinsurance, though daily copays apply for the first several days of acute and psychiatric stays. Routine vision, dental, and hearing exams are highly accessible with no copay, and the plan provides annual allowances for eyewear and hearing aids. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgent care visits carry a $40 copay. Diagnostic lab services, home infusions, and skilled nursing care for the first 20 days are also covered with no copay, though certain services like dialysis and durable medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Elite (PPO) with no coinsurance, requiring a $347 daily copay for days 1 through 7 of acute stays and a $260 daily copay for days 1 through 8 of psychiatric stays, with no copay for subsequent days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Elite (PPO) are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $325, observation services have a $325 copay per stay, and outpatient substance abuse sessions incur a $40 copay.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite (PPO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum benefit with no coinsurance and copays of $115 for emergency or urgent care and $275 for transportation.
Primary Care See details
Aetna Medicare Elite (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits range from a $0 to $55 copay with no coinsurance. Covered therapy services require a $35 copay with no coinsurance, and mental health services have a $45 copay with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Elite (PPO) preventive services are partially covered, featuring no copay and no coinsurance for annual physicals, diabetes self-management, and glaucoma screenings, though kidney disease education requires no copay and a 20% coinsurance. Supplemental options not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
Aetna Medicare Elite (PPO) covers Medicare-covered hearing exams for a $55 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (PPO) with no deductibles and no coinsurance. Eye exams carry a copay ranging from no copay to $55.00 with a $50.00 annual limit, while eyewear is covered with no copay up to a $100.00 yearly combined maximum.
Dental Services See details
Aetna Medicare Elite (PPO) partially covers dental services, featuring Medicare-covered dental care for a $55 copay and no coinsurance, as well as routine exams, cleanings, and x-rays with no copay and no coinsurance. Non-covered services include fluoride, other diagnostic or preventive services, restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers durable medical equipment, medical supplies, and diabetic services with no copay and coinsurance ranging from no coinsurance to 20%. Prosthetic devices require a 20% coinsurance with no copay, and while prior authorization is required for most equipment, diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic services have no coinsurance, with no copay for lab services and a $0 to $100 copay for diagnostic procedures, while radiological services feature no copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic services.
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 covered under the Aetna Medicare Elite (PPO) plan with no coinsurance. Covered services require a $20 copay for cardiac rehabilitation, intensive cardiac rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD), and a $15 copay for pulmonary rehabilitation.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $216 copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Elite (PPO) plan, which offers annual wellness exams, screening mammographies, and additional gFOBT and FIT tests with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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