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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 Puget Sound Area and Spokane County. 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 $14000.00 (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 $14000.00 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 meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance. During the initial coverage phase, your costs will depend on the specific drug tier and pharmacy you use. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with various copays, and emergency services with a copay. This plan also covers primary care with no copay, preventive services, and services for hearing, vision, and dental with no copays for some services, and copays for others. Additional covered services include home health with no copay, skilled nursing facilities with copays, and services for medical equipment and home infusion, with copays and coinsurance amounts varying by service. However, this plan does not cover several services, including acupuncture, over-the-counter items, and certain specialized services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $405 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include all outpatient hospital services with a copay between $0 and $390, observation services with a $425 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for several of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare SmartFit (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare SmartFit (PPO) plan. Ground ambulance services have a $275 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 under the Aetna Medicare SmartFit (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $275 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 with a $10 copay, occupational therapy services with a $30 copay, and physician specialist services with a copay between $0 and $45. Mental health specialty services, including both individual and group sessions, have a $40 copay, while physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services may have a copay, and some services like in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $2,000 every year, with more copay information available. OTC hearing aids are not covered, and prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare SmartFit (PPO) plan. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $150 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare SmartFit (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Medicare dental services have a $45 copay. There is a $1,000 maximum plan benefit each year for both in-network and out-of-network services. 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 and Other Medicare Part B Drugs are also covered, with 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.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare SmartFit (PPO) plan, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have no copay, while Diabetic Supplies have between 0% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a minimum copay of $0 and a maximum copay of $20 for Diagnostic Procedures/Tests, and no copay for Lab Services and Outpatient X-Ray Services. Diagnostic Radiological Services have a maximum copay of $275, and 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. However, 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 under the Aetna Medicare SmartFit (PPO) plan. There is no copay for days 1-20, and a $171 copay for days 21-100; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare SmartFit (PPO) plan does not cover acupuncture, over-the-counter (OTC) items, meal benefits, 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. Other 1 and Other 2 services are covered with no copay.
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