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Aetna Medicare Elite Care (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite Care (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 Care (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite Care (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in Atlanta Metro. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite Care (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 Care (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 Care (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 $350.00 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. 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 $13900.00 (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 $13900.00 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 Care (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will enjoy no copay when filling your prescriptions through a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00. For higher-tier medications, cost-sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail-order options.
Additional Benefits
The Aetna Medicare Elite Care (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a copay of $10 to $55, while inpatient hospital stays incur a daily copay of $388 for the first seven days with no copay for additional days. Emergency care is covered with a $115 copay, which is waived upon admission, and urgent care visits carry a $40 copay. Routine dental, vision, and hearing exams are covered with no copay and no coinsurance, alongside a $150 annual eyewear allowance and up to $500 per ear for hearing aids. Comprehensive dental services require a 20% to 50% coinsurance up to a $2,000 yearly limit with no copay. Durable medical equipment and prosthetics are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Elite Care (PPO) covers inpatient acute hospital stays with no coinsurance and a $388 daily copay for days 1 through 7, with no copay for additional days. Inpatient psychiatric care is covered with no coinsurance and a $407 daily copay for days 1 through 5, with no copay for days 6 through 90, though upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Elite Care (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $495, while observation services carry a $388 copay per stay and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite Care (PPO) with a copay of $105.00 or $110.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Elite Care (PPO) covers ambulance services with prior authorization, requiring a $300 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. These fees are not waived upon hospital admission, and transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Elite Care (PPO) with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency coverage is available up to a $250,000 maximum with no coinsurance and copays of $115 for emergency or urgent care and $300 for emergency transportation.
Primary Care See details
Aetna Medicare Elite Care (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 to $55 copay and no coinsurance. Therapy, psychiatric, and mental health services require copays of $35 to $55 with no coinsurance, while podiatry and chiropractic services are not covered. Telehealth benefits are also available with a $0 to $55 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite Care (PPO) preventive services are partially covered, offering no copay and no coinsurance for annual physicals, screenings, fitness, and health education, while kidney disease education has no copay but a 20% coinsurance. Chemotherapy wigs are also covered up to $400 annually with no copay and no coinsurance. However, several supplemental services—including in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, safety devices, and counseling—are not covered.
Hearing Services See details
Aetna Medicare Elite Care (PPO) covers hearing services, including Medicare-covered exams for a $55 copay and no coinsurance, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, though inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite Care (PPO) with no deductibles and no coinsurance, featuring a $0 to $55 copay for eye exams and no copay for eyewear. Routine eye exams are covered up to once per year with a $50 annual limit, and eyewear—including contacts, frames, lenses, and upgrades—is covered up to a combined annual limit of $150.
Dental Services See details
Dental services are partially covered by the Aetna Medicare Elite Care (PPO), featuring no copay and no coinsurance for routine exams, cleanings, and x-rays, alongside a $55 copay and no coinsurance for Medicare-covered dental. Comprehensive dental benefits require no copay with 20% to 50% coinsurance up to a $2,000 yearly limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite Care (PPO) covers home infusion bundled services with no copay, requiring prior authorization. Associated Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite Care (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Elite Care (PPO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and 0% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite Care (PPO) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $120 copay for diagnostic procedures. Radiological services are also covered and require prior authorization, featuring outpatient X-rays with no copay (coinsurance applies), diagnostic radiological services starting at a $0 copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite Care (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Elite Care (PPO) with no coinsurance, although some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copayments ranging from $20 to $40.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite Care (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not necessary for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Elite Care (PPO) partially covers other services with no copay and no coinsurance, including meal benefits for chronic illnesses, annual wellness exams, screening mammographies, additional gFOBT and FIT tests, and a $15 quarterly allowance for over-the-counter items. Acupuncture is not covered under this plan benefit.
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