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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 2025, 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 Greater Rochester Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $61.00. 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 $1250.00 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:
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Drug Coverage
The Aetna Medicare Elite (PPO) plan has an enhanced alternative drug benefit. The plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have 22% coinsurance.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, with lower costs for longer stays, and outpatient services have copays depending on the service. Emergency services, primary care, and specialist visits all have copays. Preventive services like annual physical exams have no copay, and vision and dental services are included. Hearing exams and hearing aids have copays. Home health and cardiac rehabilitation services have no copay, while skilled nursing facilities have a copay after the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a copay of $395 for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a copay of $339 for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while 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
The Aetna Medicare Elite (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $350, observation services with a $395 copay, and ambulatory surgical center (ASC) services with no copay. The plan also covers outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
The Aetna Medicare Elite (PPO) plan covers ambulance services with a $300 copay for both ground and air ambulance services, and 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 by the Aetna Medicare Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; there is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $30 copay. Mental health specialty services and psychiatric services are covered with a $40 copay for individual and group sessions. Other health care professional services are covered with a copay between $0 and $45. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Elite (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, and Wigs for Hair Loss have a $0 copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing services with the Aetna Medicare Elite (PPO) plan include hearing exams with a $45 copay, routine hearing exams with no copay for one visit every year, and fitting/evaluation for hearing aids with no copay for one visit every year. Prescription hearing aids are partially covered, with no copay for all types and a maximum copay of $1700 for two visits every year, 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 eye exams and eyewear. Eye exams have a copay between $0 and $45, and eyewear has a $0 copay, with a combined maximum benefit of $150 per year.
Dental Services See details
The Aetna Medicare Elite (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services like oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. Fluoride treatment, orthodontic services, restorative services, and other services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Elite (PPO) plan and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) plan and require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetics/Medical Supplies with no copay and a coinsurance for covered services, and Diabetic Equipment with a coinsurance for covered services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (PPO) plan covers Diagnostic and Radiological Services, including all diagnostic services and lab services with a copay, and outpatient X-ray services with a $45 copay. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $45. Diagnostic Radiological Services have a maximum copay of $275, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (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 by the Aetna Medicare Elite (PPO) plan, but the specific services are not covered. There is no coinsurance for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include a meal benefit with no copay, while acupuncture, over-the-counter items, and several other services are not covered. Other services such as an annual wellness exam, screening mammography, and gFOBT/FIT are covered with no copay.
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