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Aetna Medicare Elite Giveback (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite Giveback (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Elite Giveback (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite Giveback (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties Across MS. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite Giveback (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 Elite Giveback (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 Elite Giveback (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. Additionally, this plan comes with a Part B Premium reduction of $60.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $350.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 $13900.00 (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 $13900.00 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 Elite Giveback (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, beneficiaries pay no copay when utilizing preferred retail pharmacies or preferred mail-order services. If standard pharmacies or standard mail-order services are used, copays range from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs depending on the supply duration. Higher-tier medications are subject to coinsurance rather than set copayments across all pharmacy types. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates remain the same whether you use preferred or standard pharmacies, or select mail-order delivery.
Additional Benefits
The Aetna Medicare Elite Giveback (PPO) offers healthcare coverage with no copay or coinsurance for primary care visits, routine annual physicals, and routine vision and hearing exams. Specialist visits feature a copay ranging from no copay to $55, while emergency room visits require a $115 copay that is waived if you are admitted within 24 hours. For hospital stays, inpatient acute care requires a $388 daily copay for the first seven days, while outpatient hospital services feature no coinsurance and a copay ranging from no copay to $450. Preventive dental care is covered with no copay or coinsurance, and comprehensive dental services require a 20% to 50% coinsurance up to a $1,000 annual maximum. Home health services and the first 20 days of skilled nursing facility care are covered with no copay or coinsurance, with a $218 daily copay starting on day 21. Additionally, durable medical equipment and dialysis services are covered with no copay and a coinsurance of up to 20%.
Inpatient Hospital See details
Aetna Medicare Elite Giveback (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $388 daily copay for days 1-7 of acute stays and a $407 daily copay for days 1-5 of psychiatric stays, followed by no copay for remaining days. Non-Medicare-covered stays, upgrades for acute stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Elite Giveback (PPO) are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $450, while observation services have a $388 copay per stay and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Aetna Medicare Elite Giveback (PPO) covers partial hospitalization services with a copay of either $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Elite Giveback (PPO) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Aetna Medicare Elite Giveback (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are covered with a $115 copay, and worldwide emergency transportation is covered with a $295 copay, all with no coinsurance and subject to a $250,000 maximum plan benefit.
Primary Care See details
Primary care benefits under the Aetna Medicare Elite Giveback (PPO) feature no copay and no coinsurance for primary care visits, while specialist visits require a $0 to $55 copay with no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, whereas mental health, psychiatric, and opioid services have a $30 copay and no coinsurance. Chiropractic and podiatry services are not covered under this plan, but telehealth options are available with a $0 to $55 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite Giveback (PPO) offers partially covered preventive services, with most options—including annual physicals and glaucoma screenings—available with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. Covered supplemental benefits like health education and wigs have no copay and no coinsurance, but several services are not covered, including personal emergency response systems, in-home safety assessments, medical nutrition therapy, and weight management programs.
Hearing Services See details
Aetna Medicare Elite Giveback (PPO) offers hearing services with no deductible, featuring a $55 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite Giveback (PPO) covers vision services with no coinsurance and no deductibles, including routine and diabetic eye exams with no copay and Medicare-covered exams with a $0 to $55 copay. Eyewear, including contacts, frames, and lenses, is also covered with no copay up to a combined annual maximum of $100.
Dental Services See details
Dental Services are partially covered by the Aetna Medicare Elite Giveback (PPO), offering Medicare-covered dental with a $55 copay and no coinsurance, and preventive care with no copay and no coinsurance. Covered comprehensive services require no copay and 20% to 50% coinsurance up to a $1,000 annual maximum. Fluoride treatments, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite Giveback (PPO) covers Home Infusion bundled Services with no copay, although prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Elite Giveback (PPO) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite Giveback (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these services, and while diabetic therapeutic shoes and inserts carry no copay, diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Elite Giveback (PPO), featuring no copay and no coinsurance for lab services, diagnostic radiology, and outpatient X-rays. Diagnostic procedures and tests carry a copay ranging from $0 to $95 with no coinsurance, while therapeutic radiological services require a 20% coinsurance, and prior authorization is required.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Elite Giveback (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Elite Giveback (PPO) with no coinsurance, though only some services are covered because standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Elite Giveback (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite Giveback (PPO) partially covers other services, providing a meal benefit for chronic illness, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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