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Aetna Medicare Elite Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite Extra (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 Extra (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Elite Extra (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2026 to people living in Nassau and Suffolk Counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Elite Extra (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 Extra (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 Extra (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. 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 Extra (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using a preferred pharmacy or preferred mail-order service for any supply duration. If standard pharmacies or standard mail-order options are used, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36. For higher-tier medications, cost-sharing transitions from flat copays to coinsurance. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy and mail-order channels. Specialty drugs under Tier 5 are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite Extra (PPO) offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, annual physicals, and home health services. Specialist visits require a $45 copay, while emergency room care has a $115 copay that is waived if you are admitted. For hospital care, inpatient acute stays require a $399 daily copay for the first six days with no copay thereafter, and outpatient hospital services range from no copay up to a $395 copay. This plan also includes valuable dental, vision, and hearing benefits to help reduce your out-of-pocket expenses. Routine vision and hearing exams feature no copay, and dental care is covered up to a $1,000 annual maximum with no copay for most covered services. Additionally, skilled nursing facility stays are covered with no coinsurance, featuring no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Elite Extra (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a daily copay of $399 for days 1 to 6 of acute stays and $346 for days 1 to 6 of psychiatric stays, with no copay thereafter. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Elite Extra (PPO) covers outpatient services with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $399 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse services require a $45 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite Extra (PPO) with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Elite Extra (PPO) covers both ground and air ambulance services with a $290 copay and no coinsurance, though prior authorization is required. Routine transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Elite Extra (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $290.
Primary Care See details
Aetna Medicare Elite Extra (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical therapy ($35 copay), occupational therapy ($30 copay), and mental health or psychiatric sessions ($45 copay) all feature no coinsurance, while podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $45 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Elite Extra (PPO) partially covers preventive services, offering no copay and no coinsurance for annual physicals, health education, and fitness benefits, while kidney disease education has no copay but a 20% coinsurance. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Elite Extra (PPO), featuring Medicare-covered exams for a $45 copay and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $1,700 for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Elite Extra (PPO) with no deductibles and no coinsurance, featuring no copay for annual routine eye exams and up to a $45 copay for Medicare-covered exams. Prescription eyewear, including lenses, frames, and contacts, also has no copay or coinsurance up to a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are partially covered by Aetna Medicare Elite Extra (PPO) with a combined annual maximum benefit of $1,000 for both in- and out-of-network care. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered dental services have no copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Elite Extra (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Elite Extra (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Elite Extra (PPO) with no copay, although prior authorization is required. Depending on the specific item, coinsurance ranges from no coinsurance up to 19% for durable medical equipment and medical supplies, a flat 19% coinsurance for prosthetic devices, and up to 20% coinsurance for diabetic supplies and therapeutic shoes.
Diagnostic and Radiological Services See details
Aetna Medicare Elite Extra (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a copay ranging from no copay to $45 for diagnostic procedures. Radiological services require a $45 copay and coinsurance for X-rays, no coinsurance and a minimum of no copay for diagnostic radiology, and a copay and minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by Aetna Medicare Elite Extra (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Under the Aetna Medicare Elite Extra (PPO), some cardiac rehabilitation services are covered with no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD rehabilitation services are not covered and require copayments of $15 to $20.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Elite Extra (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Elite Extra (PPO), including a meal benefit for chronic illness, annual wellness exams and screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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