A non-government entity
Aetna Medicare Elite 2 NJ North (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite 2 NJ North (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 2 NJ North (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Elite 2 NJ North (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern New Jersey. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Elite 2 NJ North (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 2 NJ North (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 2 NJ North (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.00. 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 $1000.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $14000.00 (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 $14000.00 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:
Sign up for Aetna Medicare Elite 2 NJ North (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Elite 2 NJ North (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at preferred or mail order pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Elite 2 NJ North (PPO) plan offers comprehensive coverage with a variety of benefits. You'll find coverage for inpatient hospital stays with a copay, outpatient services, and emergency care, as well as primary care and preventive services with low copays or no copays. Additional benefits include hearing and vision services, dental services, home infusion, and medical equipment with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $339 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. 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 are covered by the Aetna Medicare Elite 2 NJ North (PPO) plan, including outpatient hospital services with a copay between $0 and $395, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Aetna Medicare Elite 2 NJ North (PPO) covers partial hospitalization with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $300 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 Elite 2 NJ North (PPO) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Elite 2 NJ North (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, and physician specialist services with a $40 copay. Mental health specialty services and psychiatric services each have a $40 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services also have a copay of $40. Routine Chiropractic care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including an annual physical exam, are covered with no copay. Additional preventive services, including health education, nutritional/dietary benefit, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, and wigs for hair loss related to chemotherapy, are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are covered with 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, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum copay of $1700, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Elite 2 NJ North (PPO) plan covers vision services including eye exams with a copay of $0-$40, and eyewear with no copay. Eyewear has a combined maximum benefit of $150 per year, covering both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Elite 2 NJ North (PPO) plan covers Medicare Dental Services with a $40 copay, and Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) with no copay. Fluoride Treatment, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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 Elite 2 NJ North (PPO) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Elite 2 NJ North (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20% and requires prior authorization. Prosthetic devices have a 20% coinsurance, while medical supplies have a coinsurance of 0% to 20%. Diabetic supplies have a coinsurance of 0% to 20%, and diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $40, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $325, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with a $40 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite 2 NJ North (PPO) plan with no copay and no coinsurance. However, 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 Elite 2 NJ North (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite 2 NJ North (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $190 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include coverage for a meal benefit, annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, over-the-counter items, 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved