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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 Select Counties in KY. 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 $8950.00 (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 $8950.00 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, your costs will vary based on the drug tier and the pharmacy you use. For preferred generic drugs, you have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you pay a coinsurance of 24% or 25%. After your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with varying copays. Emergency, primary care, hearing, vision, and dental services are also covered, with copays and coinsurance depending on the specific service. Additionally, the plan includes home health services with no copay, and coverage for home infusion bundled services, dialysis, and medical equipment. This plan also provides coverage for preventive services, such as an annual physical exam with no copay. The plan also covers a limited amount of over-the-counter items. However, some services like cardiac rehabilitation and personal transportation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $535 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute stays, and a copay of $455 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric stays. 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, including all outpatient hospital services, are covered by the Aetna Medicare SmartFit (PPO) plan. Outpatient hospital services have a copay between $0 and $475, observation services have a copay of $535, and ambulatory surgical center (ASC) services have no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $60. 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. For this benefit, there is a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare SmartFit (PPO) plan. Ground and Air Ambulance Services have a $290 copay, and there is no 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. For Emergency Services, there is a $125 copay and no coinsurance, with the copay waived if admitted to the hospital. Urgently Needed Services have a $35 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125 and $290, respectively, with no coinsurance.
Primary Care See details
The Aetna Medicare SmartFit (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $45 copay. The plan also covers physician specialist services with a copay between $0 and $30, and physical therapy and speech-language pathology services with a $45 copay. Mental health, psychiatric, and opioid treatment services all have a $60 copay for individual and group sessions. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $60. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare SmartFit (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, such as health education and wigs for hair loss due to chemotherapy, have no copay, while kidney disease education services have 20% coinsurance. Other services like in-home safety assessments and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, but not inner ear, outer ear, or over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $30, while routine eye exams are covered with no copay; eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $200 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, restorative services with 20-50% coinsurance, adjunctive general services with 20-50% coinsurance, endodontics with 20% coinsurance, periodontics with 20-50% coinsurance, prosthodontics (removable) with 50% coinsurance, and prosthodontics (fixed) with 50% coinsurance; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic Services have a maximum plan benefit coverage of $1000.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is 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 under the Aetna Medicare SmartFit (PPO) plan. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, Medical Supplies have a coinsurance between 0% and 20%, and Diabetic Supplies have a coinsurance between 0% and 20%.
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 $200, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $350, while Therapeutic Radiological Services have a 20% coinsurance, 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. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare SmartFit (PPO) plan. Though the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. 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
Other Services for the Aetna Medicare SmartFit (PPO) plan includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $75.00 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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