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Aetna Medicare Enhanced Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Enhanced Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Enhanced Select (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Enhanced Select (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in IL Northern and Chicago. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Enhanced Select (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 Enhanced Select (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 Enhanced Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $176.00. 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 $1500.00 (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 $1500.00 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 Enhanced Select (PPO) plan has a $590 deductible for prescription drugs. Once you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy, and 24% coinsurance for standard generic drugs at any pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy. The monthly premium is $35.90, but is reduced to $13.10 with LIS.
Additional Benefits
The Aetna Medicare Enhanced Select (PPO) plan offers comprehensive coverage with a focus on outpatient and preventive care. You'll find no copays for primary care visits, many outpatient services, and preventive services like annual physical exams. The plan also provides coverage for hearing aids, vision, and dental services, with varying copays or annual maximums. For hospital stays, there is a $200 copay for days 1-7, but no copay for days 8-90. Emergency services have a $125 copay, while ambulance services have a $275 copay for ground transport and 20% coinsurance for air transport.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, you will pay a $200 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $200, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with no copay for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Enhanced Select (PPO) plan with prior authorization required, and there is no copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Enhanced Select (PPO) plan. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Aetna Medicare Enhanced Select (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have no copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Aetna Medicare Enhanced Select (PPO) plan offers primary care services with no copay, and covers chiropractic services with no copay. Occupational therapy, physician specialist services, mental health specialty services (individual and group sessions), and other health care professional services all have no copay. Physical therapy and speech-language pathology services have no copay and no coinsurance. Additional telehealth benefits have no copay, but a 20% coinsurance. Opioid treatment program services have a copay of $0. Podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Other preventive services include Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered by the Aetna Medicare Enhanced Select (PPO) plan with no copay. Prescription Hearing Aids (all types) are covered with a maximum plan benefit coverage of $500.00 per year, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as are OTC hearing aids.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $150 per year.
Dental Services See details
Dental services are covered, with a $1,500 annual maximum benefit. Preventive services like oral exams, x-rays, and cleanings have no copay, while orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Enhanced Select (PPO) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Aetna Medicare Enhanced Select (PPO) plan covers Durable Medical Equipment (DME) with no copay and no coinsurance, though Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies, Prosthetic Devices, and Medical Supplies are covered with no copay and 0% coinsurance, while Diabetic Equipment is covered with a coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a copay for Medicare-covered Diabetes Supplies.
Diagnostic and Radiological Services See details
The Aetna Medicare Enhanced Select (PPO) plan covers diagnostic and radiological services, including lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Procedures/Tests have no copay. Therapeutic Radiological Services have no coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Enhanced Select (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Enhanced Select (PPO) plan. Specifically, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Enhanced Select (PPO) plan, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered for SNF, or non-Medicare-covered stays for SNF.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and "Other 1" and "Other 2" services with no copay; however, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, and other services are not covered. The OTC benefit offers up to $30 every three months.
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