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Aetna Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Choice (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northern Nevada. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice (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 Choice (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 Choice (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 $500.00 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 $8950.00 (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 $8950.00 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 Choice (PPO) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay 24% or 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Choice (PPO) plan offers a wide range of benefits with varying costs. This plan covers inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $305. Emergency, urgent, and primary care services are covered with copays, and preventive services are often available with no copay. Vision and dental services are included, featuring no copay for eye exams and eyewear, and a $40 copay for Medicare dental services. Hearing exams and hearing aids are covered, and home health services and skilled nursing facilities are covered with a copay. Additional benefits include ambulance services with copays and coinsurance, and home infusion with varying copays and coinsurance.
Inpatient Hospital See details
The Aetna Medicare Choice (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with prior authorization required. For acute care, you'll pay a $375 copay for days 1-5, and no copay for days 6-90; for psychiatric care, the copay is $370 for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital psychiatric are not covered, and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $305, observation services with a $375 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Choice (PPO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Choice (PPO), with all ambulance services requiring prior authorization. Ground ambulance services have a $300 copay, while air ambulance services have a 20% 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 Choice (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $300 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and mental health specialty services, psychiatric services, and opioid treatment program services with a $40 copay for individual or group sessions. Additionally, physical therapy and speech-language pathology services have a $40 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and annual physical exams with no copay. This plan also covers Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Additionally, Kidney Disease Education Services are covered with 20% coinsurance, and various other preventive services such as 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 exams, including routine hearing exams and fitting/evaluations for hearing aids, are covered with no copay, and prescription hearing aids are covered up to a maximum of $1,250 per ear every year with no copay for some types of prescription hearing aids, while OTC hearing aids and some prescription hearing aid types are not covered.
Vision Services See details
The Aetna Medicare Choice (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $195 per year for both in-network and out-of-network services.
Dental Services See details
Dental services are covered, with a $40 copay for Medicare dental services, and a $1,200 annual maximum for all other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, 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 under the Aetna Medicare Choice (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Choice (PPO) plan, with a coinsurance of 20%. Prior authorization is required for coverage.
Medical Equipment See details
The Aetna Medicare Choice (PPO) plan covers Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and requires prior authorization. Prosthetics/Medical Supplies have a coinsurance, while Diabetic Equipment includes a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts, and a copay for Medicare-covered Diabetes Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, and Outpatient X-Ray Services with no copay. Diagnostic Radiological Services have a copay of up to $295, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Choice (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Choice (PPO) plan, with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, there is a $203 copay.
Other Services See details
Other Services include Over-the-Counter (OTC) Items with no copay, and Other 1 and Other 2 services with no copay. Acupuncture, meal benefits, and several other services are not covered.
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