A non-government entity
Aetna Medicare Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Choice (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Choice (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Chicago. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Choice (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 Choice (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 Choice (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 $10100.00 (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 $10100.00 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 Choice (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 you use. For preferred generic drugs, you have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For other tiers, you will pay 24% or 25% coinsurance depending on the drug and pharmacy. 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 Choice (PPO) plan provides comprehensive coverage with a focus on outpatient services. Many services, including primary care visits, routine eye exams, and dental cleanings, have no copay. The plan also covers inpatient hospital stays, with a copay for the first few days, and offers additional benefits like hearing exams and prescription hearing aids. The plan also covers emergency services, outpatient services, and services like ambulance and partial hospitalization. Some services, such as skilled nursing facility stays and dialysis services, require copays or coinsurance. There are also coverage limits on some services, such as hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Aetna Medicare Choice (PPO) plan, with a $350 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric services are covered with a $325 copay for days 1-7, and no copay for days 8-90. The plan does not cover the Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, with a copay between $0 and $350. Observation services have a $350 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a copay of $75 for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Choice (PPO) with a $65 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Choice (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Transportation has a $275 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Choice (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, and mental health and psychiatric services with a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a copay ranging from $0 to $75, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include no copay for Annual Physical Exams, Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Wigs for Hair Loss Related to Chemotherapy are covered with a maximum plan benefit coverage amount of $400. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay and are limited to one visit per year. Prescription hearing aids are covered up to $500 per ear per year, and Prescription Hearing Aids (all types) have no copay for up to two visits per year, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including routine eye exams and eyewear, are covered. Routine eye exams have a copay of $0, while other eye exams may have a copay between $0 and $40. Eyewear benefits, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames and upgrades have no copay, but there is a combined maximum benefit of $215 per year.
Dental Services See details
Dental services are covered, including oral exams, dental x-rays, and cleanings with no copay. Medicare dental services have a $40 copay. Orthodontic services have a maximum plan benefit of $3000 per year. The plan does not cover fluoride treatments, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Choice (PPO) plan and require prior authorization. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment benefits are covered by Aetna Medicare Choice (PPO), including durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment has a coinsurance of 0% to 20%, while Diabetic Supplies have a coinsurance of 0% to 20%, Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, and lab services, with a copay between $0 and $100 for diagnostic procedures/tests and no copay for lab services. Radiological Services include coverage for diagnostic and therapeutic radiological services, and outpatient X-ray services, with a copay of up to $200 for diagnostic radiological services and no copay for outpatient X-ray services, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Choice (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Choice (PPO) plan, but no specific services are covered. There is a copay for some services, but the specific copay information is not available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Choice (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
Under "Other Services," Aetna Medicare Choice (PPO) covers Over-the-Counter (OTC) Items with no copay, and a maximum plan benefit coverage amount of $75.00 every three months. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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