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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 Massachusetts. 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 $157.00. 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 $450.00 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 $450 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you will pay no copay if you use a preferred pharmacy or preferred mail order. Standard generic drugs have 22% coinsurance, and preferred brand drugs have 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Enhanced Select (PPO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $250 copay for the first 5 days, then no copay for the next 85 days. Outpatient services, including primary care and specialist visits, have copays ranging from $0 to $30. The plan also includes coverage for hearing, vision, and dental services. Preventive services, like annual physical exams, have no copay. Emergency services, including urgent and worldwide emergency care, have copays between $30 and $110. The plan covers ambulance services with a $300 copay for ground transport and 20% coinsurance for air transport. Additionally, the plan covers skilled nursing facilities, home health services, and offers a $75 allowance for over-the-counter items every three months.
Inpatient Hospital See details
The Aetna Medicare Enhanced Select (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For the first 5 days, there is a $250 copay per admission, and days 6-90 have no copay; there is no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay. However, 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 coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $250, observation services have no copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Enhanced Select (PPO) plan, but requires prior authorization. You will have a copay of $80 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 $300 copay, while air ambulance services have a 20% coinsurance; however, 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 Enhanced Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $300 copay; all services have no coinsurance.
Primary Care See details
Primary Care benefits include no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services (excluding Routine Care), and a $25 copay for Occupational Therapy Services. Physician Specialist Services and Other Health Care Professional services have copays ranging from $0-$30, while Mental Health and Psychiatric Services have a $30 and $25 copay, respectively, for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $20 copay, and Additional Telehealth Benefits include a 20% coinsurance and a copay between $0 and $30. Opioid Treatment Program Services have a $30 copay. 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, and additional preventive services with varying copays. Kidney disease education services have a 20% coinsurance, and other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay for 1 visit every year, and fitting/evaluation for hearing aids with no copay for 1 visit every year. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$30, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is also covered, with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $250 per year.
Dental Services See details
Dental services are covered, with a $1,000 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, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Enhanced Select (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Enhanced Select (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a coinsurance, and Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 0-20% coinsurance, and Diabetic Equipment has a coinsurance, with Diabetic Supplies having a 0-20% coinsurance and Diabetic Therapeutic Shoes/Inserts having a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic procedures/tests and lab services have no copay, while diagnostic radiological services have a copay of at most $150, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under 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 not covered by the Aetna Medicare Enhanced Select (PPO) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Enhanced Select (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which have no copay and a $75 maximum benefit every three months. The plan also covers Meal Benefits with no copay, and Other 1 and Other 2 services with no copay. 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.
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