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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 Northwest and Northeast. 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. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay a coinsurance of 24% or 25% depending on the drug and pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for your covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers comprehensive coverage with varying cost-sharing options. Inpatient hospital stays have a copay, while outpatient services may have a copay depending on the service. The plan also includes coverage for primary care with no copay for physician services, preventive services, hearing exams, vision exams and eyewear, and dental services, but with copays or coinsurance for some services. Additional benefits include coverage for ambulance services, emergency services, home health services with no copay, and over-the-counter items up to a certain amount. Diagnostic and radiological services are covered with different copays and coinsurance. The plan also provides coverage for home infusion bundled services, dialysis services, and medical equipment with copays or coinsurance.
Inpatient Hospital See details
The Aetna Medicare SmartFit (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For inpatient hospital-acute, you pay a $350 copay for days 1-7, and no copay for days 8-90; for inpatient hospital psychiatric, you pay a $325 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Aetna Medicare SmartFit (PPO) plan with a copay of $0-$350 for Outpatient Hospital Services and $350 for Observation Services. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay of $75 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by 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. Ground ambulance services have a $285 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 the Aetna Medicare SmartFit (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation.
Primary Care See details
Under the Aetna Medicare SmartFit (PPO) plan, primary care services include no copay for primary care physician services, a $20 copay for chiropractic services (routine care is not covered), a $45 copay for occupational therapy services, a $45 copay for physician specialist services, and a $45 copay for physical therapy and speech-language pathology services. Mental health and psychiatric services have a $40 copay, and opioid treatment services have a copay between $40. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75. Other health care professionals have a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Kidney Disease Education Services have a 20% coinsurance, while additional preventive services are covered, including specific services with no copay. Some services, like In-Home Safety Assessment, are not covered.
Hearing Services See details
The Aetna Medicare SmartFit (PPO) plan covers hearing exams for a $45 copay, with Routine Hearing Exams and Fitting/Evaluation for Hearing Aid both covered with no copay. Prescription Hearing Aids are covered up to $500 per year, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams, with a copay between $0 and $45, as well as coverage for routine eye exams and other eye exam services with no copay. Eyewear is also covered, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, and a combined maximum benefit of $125 per year.
Dental Services See details
The Aetna Medicare SmartFit (PPO) plan covers Medicare dental services with a $45 copay, and other dental services including oral exams, dental x-rays, and cleanings with no copay. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with a 20% - 50% coinsurance. Orthodontic services are covered up to a maximum of $2000 per year, and fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare SmartFit (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare SmartFit (PPO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic equipment is also covered, with a coinsurance for therapeutic shoes/inserts and a copay for diabetes supplies.
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, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, and Outpatient X-Ray Services have a $20 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare SmartFit (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 SmartFit (PPO) plan, but the specific services are not covered. The plan does not list any copay or coinsurance information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartFit (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered 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, and Other 1 and Other 2 benefits with no copay. Acupuncture, Meal Benefit, 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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