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Aetna Medicare Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maryland Service Area. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite (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 (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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 has a $1200.00 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 $7750.00 (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 $7750.00 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 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply. For higher-tier medications, cost-sharing transitions to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. This structure helps you estimate your out-of-pocket prescription costs under this plan.
Additional Benefits
The Aetna Medicare Elite (PPO) plan provides comprehensive coverage for core medical needs, featuring no copay for primary care visits and routine preventive services. Specialist visits range from no copay to a $60 copay, while inpatient hospital stays require a daily copay for the first eight days with no coinsurance. Emergency care is available with a $130 copay, which is waived upon hospital admission, and urgent care has a $50 copay. For supplemental wellness, this plan covers routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and prescription hearing aids. Home health services are also covered with no copay, while comprehensive dental and medical equipment require varying coinsurance up to 50 percent. Skilled nursing facility stays are covered with daily copays and no coinsurance for the first 100 days.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) partially covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute stays require prior authorization and a $335 daily copay for days 1 to 8 with no copay for additional days, while psychiatric stays require prior authorization and a $292 daily copay for days 1 to 8 with no copay for days 9 to 90.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $335, observation services have a $335 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Aetna Medicare Elite (PPO) covers partial hospitalization services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Elite (PPO) with a $325 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Elite (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgent care with a $50 copay and no coinsurance. Worldwide emergency services are also covered up to a $250,000 limit with no coinsurance, featuring a $130 copay for emergency or urgent care and a $325 copay for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Elite (PPO) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $0 to $60 copay and no coinsurance. Physical, occupational, and speech therapy services carry a $20 copay and no coinsurance, while mental health and psychiatric sessions require a $40 copay and no coinsurance. Podiatry and chiropractic services are not covered, and telehealth benefits are available with a $0 to $60 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite (PPO), featuring no copay and no coinsurance for annual physical exams, glaucoma screenings, and fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. Several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
Hearing services covered by Aetna Medicare Elite (PPO) include Medicare-covered exams for a $60 copay and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 annual maximum per ear, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite (PPO) with no coinsurance and copays ranging from $0 to $60 for eye exams, which include a $0 copay routine exam once per year up to a $50 maximum. Covered eyewear, including lenses, frames, and contact lenses, has no copay and no coinsurance up to a combined annual limit of $100.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Elite (PPO), offering no copay and no coinsurance for preventive care like cleanings and exams, and a $60 copay with no coinsurance for Medicare-covered dental. Comprehensive services require no copay with 20% to 50% coinsurance, but fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Elite (PPO) with no copays, though coinsurance ranges from no coinsurance to 20% depending on the equipment. This benefit covers durable medical equipment, prosthetics, medical supplies, and diabetic services, all of which require prior authorization.
Diagnostic and Radiological Services See details
Aetna Medicare Elite (PPO) covers diagnostic and radiological services with prior authorization required, offering diagnostic services with no coinsurance, no copay for lab work, and a $0 to $100 copay for diagnostic procedures. Covered radiological services feature no copay for outpatient X-rays and diagnostic radiology, while therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the Aetna Medicare Elite (PPO), but only some services are covered in practice. Standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
Aetna Medicare Elite (PPO) partially covers other services, offering a chronic illness meal benefit, 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 plan.
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