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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Elite (PPO) is a PPO plan offered by Aetna Life Insurance Company available for the 2026 plan year to people living in Metro: Manhattan. This plan received an overall rating of 4.5 out of 5 stars in 2026.
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 $54.00. 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 $1500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9250.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $9250.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 (PPO)
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Drug Coverage
The Aetna Medicare Elite (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail order, Tier 1 copays range from $2 to $6 and Tier 2 copays range from $12 to $36 depending on the prescription length. Higher-tier medications require coinsurance rather than flat copays. You will pay a 24% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs and Tier 5 specialty drugs.
Additional Benefits
The Aetna Medicare Elite PPO plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits carry a low copay ranging from no copay to $45, while inpatient hospital stays require a $399 daily copay for the first six days with no copay thereafter. Outpatient hospital services and diagnostic procedures are also covered with no coinsurance and varying copays. Emergency care is accessible with a $115 copay that is waived if admitted, while urgent care visits require a $40 copay. Routine dental, vision, and hearing exams are fully covered with no copay or coinsurance, alongside additional benefits for prescription hearing aids and eyewear. Medical equipment and supplies are covered with no copays, though coinsurance ranges up to 20 percent depending on the item.
Inpatient Hospital See details
Aetna Medicare Elite (PPO) covers inpatient acute hospital stays with no coinsurance and a $399 daily copay for days 1 to 6 (no copay thereafter), excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric care is covered with no coinsurance and a $346 daily copay for days 1 to 6 (no copay for days 7 to 90), though additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Elite (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a copay of $0 to $395, observation services carry a $399 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Aetna Medicare Elite (PPO) plan with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Aetna Medicare Elite (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, although prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite (PPO) with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $115 to $275, up to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Elite (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Therapy services require copays of $30 to $35 with no coinsurance, while chiropractic services are only partially covered with routine care excluded, and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Elite (PPO) preventive services are partially covered, offering an annual physical exam, screenings, and select supplemental benefits like health education and memory fitness with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while excluded sub-services include PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety assessments, and counseling.
Hearing Services See details
Aetna Medicare Elite (PPO) provides partially covered hearing services with no deductible, featuring a $45 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays ranging from no copay to $1,700 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite (PPO) covers vision services with no deductibles or coinsurance, offering eye exams with copays ranging from no copay to $45 (up to a $50 annual limit) and one routine exam per year with no copay. Eyewear is also covered with no copay and no coinsurance up to a combined annual maximum of $100 for contacts, frames, and lenses.
Dental Services See details
Aetna Medicare Elite (PPO) partially covers dental services, offering Medicare-covered dental care for a $45 copay and no coinsurance, alongside routine oral exams, cleanings, and x-rays with no copay and no coinsurance. However, fluoride, other diagnostic or preventive services, orthodontics, restorative services, endodontics, periodontics, prosthodontics, implants, and oral surgery are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Elite (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Elite (PPO) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment and medical supplies feature coinsurance ranging from no coinsurance up to 18%, while prosthetic devices carry an 18% coinsurance and diabetic equipment ranges from no coinsurance up to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Elite (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $45 copay for procedures, while radiological services range from a $0 minimum copay for diagnostic radiology to a $45 copay with coinsurance for X-rays, and a copay with a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Aetna Medicare Elite (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Aetna Medicare Elite (PPO) with no coinsurance, meaning some services are covered, but in practice, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Elite (PPO) plan, featuring no copay and no coinsurance for eligible chronic illness meal benefits, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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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.
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