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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 Metro Area: Bronx, Brooklyn, Queens. 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 $44.00. 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 $1000.00 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 drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling prescriptions through preferred pharmacies or preferred mail order services. If you use standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply duration. For brand and specialty medications, your costs are based on a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy types and supply durations. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty tier coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Elite Extra (PPO) plan provides foundational medical coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Specialist visits require a $40 copay, while inpatient hospital stays carry a $950 copay per admission with no coinsurance. Emergency care is accessible with a $115 copay, and skilled nursing facility stays feature no copay for the first 20 days before transitioning to a $218 daily copay. For supplemental care, the plan offers dental, vision, and hearing benefits with no deductibles and no copays for routine services, including a $1,500 annual maximum for covered dental care. Prescription hearing aids require copays ranging from no copay up to $1,700, while diagnostic lab tests and home infusion services are also available with no copay. Durable medical equipment is covered with no copay and coinsurance ranging from zero to 20 percent.
Inpatient Hospital See details
Aetna Medicare Elite Extra (PPO) covers inpatient acute hospital stays with a $950 copay per admission and no coinsurance, and inpatient psychiatric care with a $346 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required for these services, which feature no coinsurance, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Elite Extra (PPO) are covered with no coinsurance, featuring a $0 to $399 copay for outpatient hospital services and a $399 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse group and individual sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Elite Extra (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Elite Extra (PPO) covers ground and air ambulance services with a $275 copay and no coinsurance, though prior authorization is required. While transportation services are technically covered, specific options like transportation to plan-approved or any health-related locations are not covered in practice.
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 and no coinsurance, while worldwide emergency services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $275 depending on the service.
Primary Care See details
Aetna Medicare Elite Extra (PPO) offers primary care visits with no copay and no coinsurance, specialist visits with a $40 copay and no coinsurance, and physical, occupational, and speech therapies with a $30 copay and no coinsurance. Telehealth benefits are available with a $0 to $40 copay and 20% coinsurance, but podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services under the Aetna Medicare Elite Extra (PPO) are partially covered, featuring no copay and no coinsurance for annual physical exams, health education, and standard screenings. While kidney disease education requires a 20% coinsurance and no copay, other benefits like wigs for chemotherapy are covered up to $400 annually, though services such as weight management, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Elite Extra (PPO) covers hearing services with no deductible, offering annual routine exams and fitting evaluations for no copay and no coinsurance, while Medicare-covered exams require a $40 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $0 to $1,700 and no coinsurance, but over-the-counter (OTC) hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Elite Extra (PPO) with no deductible and no coinsurance, featuring routine eye exams with no copay and other exams for a $0 to $40 copay, up to a $50 annual maximum. Covered eyewear, including contacts and eyeglasses, has no copay and is subject to a $100 combined annual benefit limit.
Dental Services See details
Aetna Medicare Elite Extra (PPO) provides partially covered dental services with a combined in- and out-of-network maximum annual benefit of $1,500. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive 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 and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs carry no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Aetna Medicare Elite Extra (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Elite Extra (PPO) with no copays, though prior authorization is required and coinsurance ranges from no coinsurance to 20%. This benefit includes durable medical equipment, medical supplies, prosthetics, and diabetic equipment, though diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Elite Extra (PPO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a copay of up to $40 for procedures, while radiological services include a $40 copay for X-rays, a minimum of no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Aetna Medicare Elite Extra (PPO) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Elite Extra (PPO) indicates some services are covered for cardiac rehabilitation with no coinsurance, but in practice, key services are not covered. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and SET for PAD services are not covered and require a $20 copay, while Pulmonary Rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite Extra (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 prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite Extra (PPO) partially covers other services, offering a chronic illness meal benefit, annual wellness exams and screening mammography, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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