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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 Southwest. 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 you meet your deductible, you will pay the following costs for your prescriptions depending on the drug tier and pharmacy. For tier 1 preferred generic drugs, you will have no copay if you use a preferred pharmacy or preferred mail order. For tier 2 standard generic drugs, you will pay 24% coinsurance, regardless of the pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services. You'll have a $300 copay for the first few days of inpatient hospital stays, and varying copays for outpatient services, such as $0-$300 for outpatient hospital services. The plan also covers emergency services with a copay of $125. Preventive services like an annual physical exam are covered with no copay, and vision and dental services are also available. You'll have no copay for routine eye exams and eyewear, and dental services are covered with no copay. The plan also includes coverage for hearing exams, hearing aids, and home health services with no copay, and offers a maximum benefit for dental services of $2,000 per year.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $300 copay for days 1-8, and no copay for days 9-90; for Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-7, and no copay for days 8-90. Additional days and upgrades for both are not covered, and non-Medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare SmartFit (PPO) plan. Outpatient Hospital Services have a copay of $0 to $300, Observation Services have a $300 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75. Outpatient Blood Services have no copay.
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 benefit.
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 $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 has a $125 copay, Urgently Needed Services has a $35 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $285 copay.
Primary Care See details
The Aetna Medicare SmartFit (PPO) plan covers primary care services, including no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, a $30 copay for Occupational Therapy Services, and a $0-$30 copay for Physician Specialist Services. The plan also covers mental health, psychiatric, physical therapy, speech-language pathology, telehealth, and opioid treatment services, with varying copays and in some cases, prior authorization required. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy. Kidney Disease Education Services have a 20% coinsurance, and Other Preventive Services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services with Aetna Medicare SmartFit (PPO) include hearing exams with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per year, while OTC hearing aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Aetna Medicare SmartFit (PPO) covers vision services, including eye exams with a copay of $0-$30 and routine eye exams with no copay, and eyewear with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, up to a combined maximum of $220 per year.
Dental Services See details
Aetna Medicare SmartFit (PPO) offers 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. Medicare dental services have a $30 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a $2,000 maximum benefit per year for both in-network and out-of-network services.
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 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, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare SmartFit (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, while prosthetic devices have a 20% coinsurance; medical supplies have a coinsurance between 0% and 20%. Diabetic supplies have a coinsurance between 0% and 20%, and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare SmartFit (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a coinsurance of 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 not covered under the Aetna Medicare SmartFit (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
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 per day, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Aetna Medicare SmartFit (PPO) plan, acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and several other services are not covered. Over-the-counter (OTC) items and "Other 1" and "Other 2" benefits are covered with no copay.
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