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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 Westchester and Rockland 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 $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 has an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay when you use preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order services charge a copay ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 medications depending on the supply filled. For Tier 3 preferred brand drugs, you will pay a 24% coinsurance regardless of the pharmacy type or supply length. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy and mail-order options. Specialty tier medications under this plan are only available in a one-month supply.
Additional Benefits
The Aetna Medicare Elite Extra (PPO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a $45 copay, while acute inpatient hospital stays incur a $950 copay per admission with no copay for unlimited additional days. Emergency care is available with a $115 copay, which is waived if you are admitted within 24 hours, and urgent care services carry a $40 copay. For supplemental benefits, the plan features no copay or coinsurance for routine vision and dental services, including a $1,500 annual dental limit and a $100 yearly eyewear allowance. Routine hearing exams also have no copay, while prescription hearing aids require copays up to $1,700. Skilled nursing facility stays are covered with no copay for the first 20 days, and durable medical equipment is available with no copay and coinsurance ranging up to 20 percent.
Inpatient Hospital See details
Aetna Medicare Elite Extra (PPO) covers inpatient hospital services with no coinsurance and required prior authorization, though upgrades and non-Medicare-covered stays are not covered. Acute stays require a $950 copay per admission with no copay for unlimited additional days, while psychiatric stays require a $346 daily copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
Aetna Medicare Elite Extra (PPO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $399 (including $399 per stay for observation services), while outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Elite Extra (PPO) with a copay of either $105.00 or $110.00 and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Elite Extra (PPO) covers ground and air ambulance services with a $270 copay per service and no coinsurance, although prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
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, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $270.
Primary Care See details
Aetna Medicare Elite Extra (PPO) features primary care physician services with no copay and no coinsurance, and specialist physician services with a $45 copay and no coinsurance. Standard physical, occupational, and speech therapy services require a $30 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Elite Extra (PPO), offering no copay and no coinsurance for annual physicals, health education, and select screenings, though kidney disease education requires a 20% coinsurance with no copay. Supplemental options like in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, telemonitoring, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Elite Extra (PPO), featuring a $45 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no coinsurance and copays up to $1,700, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Elite Extra (PPO) covers vision services with no deductible and no coinsurance, featuring eye exams with a copay ranging from $0 to $45 and a $50 annual maximum. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a combined maximum benefit of $100 every year.
Dental Services See details
Aetna Medicare Elite Extra (PPO) partially covers dental services up to a $1,500 annual limit for both in-network and out-of-network care, with no copay and no coinsurance for most preventive and comprehensive services. Medicare-covered dental services require a $45 copay and no coinsurance, while 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 may be required. Under this benefit, Part B chemotherapy, radiation, and other 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 under the Aetna Medicare Elite Extra (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Aetna Medicare Elite Extra (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic equipment, with no copays and prior authorization required. Coinsurance ranges from no coinsurance to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices and diabetic therapeutic shoes or inserts require a 20% coinsurance.
Diagnostic and Radiological Services See details
Aetna Medicare Elite Extra (PPO) covers diagnostic and radiological services, featuring no coinsurance for diagnostic tests and procedures which have a $0 to $45 copay, alongside lab services with no copay. Radiological services require prior authorization and include a $0 minimum copay for diagnostic radiology, a $45 copay plus coinsurance for X-rays, and a minimum 20% coinsurance plus copays 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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Aetna Medicare Elite Extra (PPO) with no coinsurance, though only some services are covered in practice as standard cardiac, intensive cardiac, and SET for PAD services (each with a $20 copay), and pulmonary services (with a $15 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Elite Extra (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Elite Extra (PPO) partially covers other services, providing a meal benefit for chronic illness, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and dual-eligible SNP services are not covered.
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