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Aetna Medicare Enhanced Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Enhanced Select (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Enhanced Select (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern Maine. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Enhanced Select (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 Enhanced Select (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 Enhanced Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $112.00. 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 $250.00 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 $9500.00 (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 $9500.00 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 Enhanced Select (PPO) plan has a $250 deductible for prescription drugs. After you meet your deductible, your costs will vary depending on the drug tier and pharmacy you use. For generic drugs, you will pay a copay of $10-12 at the pharmacy. For brand-name drugs, you will pay coinsurance between 25-30%. After your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D drugs.
Additional Benefits
The Aetna Medicare Enhanced Select (PPO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have a mix of copays and no copays depending on the service. Primary care, preventive services, vision, dental, and home health services often have no copay, while hearing services and other specialist services may have a copay. This plan includes coverage for ambulance services, emergency services, and a wide range of diagnostic and therapeutic services. The plan also covers services such as skilled nursing facilities, home infusion, and medical equipment with varying cost-sharing. Some services like outpatient substance abuse, mental health, and cardiac rehabilitation services have copays.
Inpatient Hospital See details
The Aetna Medicare Enhanced Select (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with a copay of $250 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $275 for days 1-7 and no copay for days 8-90 for psychiatric care. Additional days and upgrades for inpatient hospital-acute and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services have a copay between $0 and $335, Observation Services have a $325 copay, Ambulatory Surgical Center (ASC) Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Enhanced Select (PPO) plan, but requires prior authorization. You will pay a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Enhanced Select (PPO). Ground ambulance services have a $295 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 Enhanced Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $295 copay; all have no coinsurance.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay between $0 and $30, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions, and Opioid Treatment Program Services have a $40 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services like health education, nutritional/dietary benefits, and wigs for hair loss related to chemotherapy are covered. Kidney disease education services have a 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $40 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered with a copay up to $1700, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers vision services, including eye exams with a copay between $0 and $40, and eyewear with no copay and a combined maximum benefit of $225 per year. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers dental services with a $1,500 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 Enhanced Select (PPO) plan. There is a coinsurance of 20% for these services.
Medical Equipment See details
The Aetna Medicare Enhanced Select (PPO) plan covers medical equipment including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and 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, including all diagnostic services, diagnostic procedures, and lab services, are covered. Diagnostic procedures have a copay between $0 and $40, and diagnostic radiological services have a copay up to $150. Therapeutic radiological services have 20% coinsurance, and outpatient x-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Enhanced Select (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, but not the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified in this summary.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Enhanced Select (PPO) plan, but prior authorization is required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214, while additional and non-Medicare covered SNF days are not covered.
Other Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay, while acupuncture, 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 are not covered. Other services such as annual wellness exams and screening mammography, and gFOBT, FIT are covered with no copay.
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