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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 Metro: Staten Island. 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 $0.00. 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:
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Drug Coverage
The Aetna Medicare Elite (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you will have no copay at preferred pharmacies or through preferred mail order, otherwise, you will pay a $12 copay. For standard generic, preferred brand, and non-preferred drugs, you will pay 22% or 25% coinsurance, depending on the drug and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency services and ambulance services have copays, and primary care visits have a $5 copay, with specialist visits costing $45. Preventive services, home health services, and many vision and dental services are available with no copay. Diagnostic services and skilled nursing facilities also have copays. The plan includes coverage for hearing aids, home infusion, and medical equipment with differing cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you have a $350 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, the copay is $339 for days 1-6, and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services under the Aetna Medicare Elite (PPO) plan include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $350 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay of $45, and Outpatient Blood Services with no copay. Outpatient Blood Services include an enhanced benefit where the three-pint deductible is waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Elite (PPO) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Elite (PPO). This plan has a $280 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, Worldwide Emergency Transportation has a $280 copay, and Urgently Needed Services has a $45 copay; all services have no coinsurance.
Primary Care See details
Under the Aetna Medicare Elite (PPO) plan, primary care physician services have a $5 copay, chiropractic services have a $15 copay, and occupational therapy services have a $30 copay. Physician specialist services have a $45 copay, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services, as well as opioid treatment programs, have a $45 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with no copay for services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, with one visit covered per year for each service. Prescription hearing aids are partially covered, with a maximum copay of $1,700 for all types of prescription hearing aids, 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, with routine eye exams and other eye exam services having no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $200 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 and dental x-rays with no copay, and prophylaxis (cleaning) with no copay. However, fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Elite (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Elite (PPO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Durable Medical Equipment for use outside the home is not covered. 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.
Diagnostic and Radiological Services See details
The Aetna Medicare Elite (PPO) plan covers diagnostic and radiological services, including all diagnostic services, diagnostic procedures/tests with a copay ranging from $0 to $45, and lab services with no copay. Therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a $45 copay.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Elite (PPO) 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 none of the listed sub-services are covered. The plan does not specify the copay or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Under "Other Services," the Aetna Medicare Elite (PPO) plan does not cover acupuncture, over-the-counter items, or several other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Private Duty Nursing Services. The plan offers a meal benefit and covers annual wellness exams and screening mammography, with no copay.
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