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Aetna Medicare SmartFit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare SmartFit (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare SmartFit (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare SmartFit (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in MI Southeast. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare SmartFit (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 SmartFit (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 SmartFit (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 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 $8250.00 (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 $8250.00 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 SmartFit (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies or mail order, or a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance, and preferred and non-preferred brand drugs have a 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a copay, while outpatient services and primary care visits may have no copay or a small copay. Preventive services, including an annual physical exam, are covered with no copay, and the plan also includes benefits for hearing, vision, and dental care, with some services having no copay. The plan covers emergency services, ambulance services, and home health services, each with different copays or coinsurance. Additional benefits include coverage for home infusion, dialysis, and medical equipment, each with different cost-sharing structures. Some services, such as cardiac rehabilitation and certain other services, are not covered under this plan.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare SmartFit (PPO) plan. For Inpatient Hospital-Acute, you will pay a $315 copay for days 1-8, and no copay for days 9-90; Additional Days for Inpatient Hospital-Acute are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $315 copay for days 1-7, and no copay for days 8-90. 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 coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $315, observation services have a $315 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $75.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare SmartFit (PPO) plan, but requires prior authorization. You will have a $75 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare SmartFit (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $255 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 SmartFit (PPO). Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services have a $125 or $255 copay depending on the service.
Primary Care See details
The Aetna Medicare SmartFit (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a copay between $0 and $35, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. Mental Health and Psychiatric Services have a $40 copay for both individual and group sessions, while Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75. Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services, including health education, nutritional/dietary benefits, wigs for hair loss, additional sessions of smoking cessation counseling, fitness benefits, and remote access technologies. Kidney Disease Education Services has a 20% coinsurance. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, Routine Hearing Exams with no copay for up to 1 visit per year, and Fitting/Evaluation for Hearing Aid with no copay for up to 1 visit per year. Prescription Hearing Aids have a maximum benefit of $750 per ear every year, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered by the Aetna Medicare SmartFit (PPO) plan, including eye exams with a copay of $0-$35, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $250 per year.
Dental Services See details
The Aetna Medicare SmartFit (PPO) plan covers various 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. The plan has a $2,500 annual maximum for dental services. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare SmartFit (PPO) plan, requiring prior authorization. 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 SmartFit (PPO) plan, 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 (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for certain services. Diabetic equipment is also covered, with a coinsurance and copay for specific services.
Diagnostic and Radiological Services See details
The Aetna Medicare SmartFit (PPO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $290, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare SmartFit (PPO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare SmartFit (PPO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartFit (PPO) plan, but require prior authorization. You will pay a $10 copay for days 1-20, and a $205 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay and Other 1 and Other 2 with no copay. Acupuncture, Meal Benefit, 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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