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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 IN Central. 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 $10100.00 (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 $10100.00 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. In the initial coverage phase, you'll pay different amounts depending on the drug tier and pharmacy type. For example, you'll pay no copay for preferred generic drugs at preferred pharmacies. For standard generic drugs, you pay 24% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a range of benefits with varying cost-sharing. You'll find no copays for primary care visits, preventive services, routine eye exams, and many dental services. The plan also includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays and coinsurance applying to some services like ambulance, specialist visits, and diagnostic tests.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare SmartFit (PPO) plan. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, offered by Aetna Medicare SmartFit (PPO), includes coverage for outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, and outpatient substance abuse services with a $75 copay for both individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare SmartFit (PPO) plan, but requires prior authorization. You will pay 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. Ground Ambulance Services have a copay of $295, 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 the Aetna Medicare SmartFit (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $295 copay, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare SmartFit (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. Specialist visits have a $40 copay, and physical therapy has a $40 copay. Mental health and psychiatric services, as well as opioid treatment programs, all have a $40 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and wigs for hair loss, which have a $0 copay. Kidney Disease Education Services have 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year) with no copay. Prescription hearing aids are covered up to $500 per ear every year, while over-the-counter hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams have no copay; eyewear has no copay, with a combined maximum benefit of $150 per year for both in-network and out-of-network services.
Dental Services See details
Dental services are covered, including oral exams with no copay for up to 4 visits per year, dental x-rays with no copay for up to 3, and prophylaxis (cleaning) with no copay for up to 2 visits per year. Medicare dental services have a $40 copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%, and prosthodontics (removable) and fixed have a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require 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.
Medical Equipment See details
The Aetna Medicare SmartFit (PPO) plan covers Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance between 0% and 20%. Diabetic Equipment is covered, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare SmartFit (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, while Therapeutic Radiological Services have coinsurance of at least 20%. Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare SmartFit (PPO) with no copay and no coinsurance, but 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 SmartFit (PPO) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. 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 SmartFit (PPO) plan. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare SmartFit (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $50 every three months. Other services like acupuncture, meal benefits, and many other services are not covered.
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