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Aetna Medicare SmartFit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare SmartFit (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare SmartFit (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare SmartFit (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare SmartFit (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 SmartFit (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 SmartFit (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $7550.00 (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 $7550.00 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 SmartFit (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay no copay at preferred pharmacies or mail order. For standard generic drugs, you will pay 22% coinsurance, and for preferred brand drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare SmartFit (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including primary care, have a mix of copays and no copays depending on the service. Emergency, hearing, vision, and dental services are covered, with copays and coinsurance applying to some services. The plan covers home health services with no copay, along with durable medical equipment, prosthetics, and diabetic equipment, which have coinsurance. It also includes coverage for skilled nursing facility services with a copay for a limited number of days, and covers outpatient services and offers a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits for Aetna Medicare SmartFit (PPO) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $445 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $380 copay for days 1-6, and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Aetna Medicare SmartFit (PPO) plan. Outpatient Hospital Services have a copay between $0 and $475, Observation Services have a $445 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $55.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare SmartFit (PPO) plan, but requires prior authorization, and has a copay of $85.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare SmartFit (PPO) plan. Ground and Air Ambulance Services have a $325 copay, with no coinsurance, but 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 SmartFit (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have varying copays: $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $325 for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare SmartFit (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $45 copay, while physician specialist services have a copay between $0 and $40. Mental health and psychiatric services, including individual and group sessions, have a $55 copay. Physical therapy and speech-language pathology services have a $45 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services have a $55 copay.
Preventive Services See details
The Aetna Medicare SmartFit (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services are covered, and include 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 Services with the Aetna Medicare SmartFit (PPO) plan includes hearing exams with a $30 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and Prescription Hearing Aids (all types) are covered with a maximum copay of $1700, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Aetna Medicare SmartFit (PPO) plan covers vision services, including eye exams with a copay of $0-$30, and eyewear with no copay. Eyewear has a combined maximum plan benefit coverage of $195 per year for both in and out-of-network services.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $30 copay, oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance between 20% and 50%, while Maxillofacial Prosthetics, Implant Services, 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 for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare SmartFit (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment. DME has a coinsurance of 0-20%, while durable medical equipment for use outside the home is not covered. Prosthetic devices and diabetic therapeutic shoes/inserts have a 20% coinsurance, while medical supplies and diabetic supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $250, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $350, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare SmartFit (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 not covered by the Aetna Medicare SmartFit (PPO) plan. While Cardiac Rehabilitation Services are mentioned as a covered benefit, the plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare SmartFit (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare SmartFit (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $50 every three months. Acupuncture, meal benefits, and various other services are not covered.
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