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Aetna Medicare Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Elite (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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Elite (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in North Dakota. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Elite (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 (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 (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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $8950.00 (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 $8950.00 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 (PPO) plan has an enhanced alternative drug benefit. You must first satisfy a deductible of $590 before your drug coverage begins. After your deductible is met, you will pay a $0 copay for preferred generic drugs at a preferred pharmacy, and 24% coinsurance for standard generic drugs. You will also pay 25% coinsurance for preferred brand and non-preferred drugs, regardless of the pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Elite (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, with no copay for days 7-90. Outpatient services have copays depending on the service, and emergency services have a copay. Primary care visits have no copay, while specialist visits have a copay. Preventive services, including an annual physical, have no copay. The plan also covers hearing exams, hearing aids, vision services, and many dental services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Elite (PPO) plan. For Inpatient Hospital-Acute, you will pay a $370 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric has a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $370, observation services have a $370 copay, ambulatory surgical center (ASC) services have no copay, individual and group sessions for outpatient substance abuse have a copay of $40, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Elite (PPO) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Elite (PPO) plan. Ground ambulance services have a $350 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Elite (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency and Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation, with a maximum plan benefit of $150,000.
Primary Care See details
The Aetna Medicare Elite (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $35 copay, and physician specialist services with a $35 copay. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services are covered with a $35 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $50. Routine chiropractic care is not covered and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like health education, wigs for hair loss, nutritional/dietary benefit, additional sessions of smoking cessation counseling, fitness benefit, 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 are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay; prescription hearing aids are covered, with a maximum benefit of $1250 per ear every year, and prescription hearing aids (all types) are covered with no copay, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay. A combined maximum of $230 is covered for eyewear every year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $500 annual maximum for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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 Elite (PPO) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 20% coinsurance, and Prosthetics/Medical Supplies with 0% to 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Elite (PPO). Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $275, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a copay of $10.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Elite (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 covered by the Aetna Medicare Elite (PPO) plan, but the specific services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Elite (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Under "Other Services", the Aetna Medicare Elite (PPO) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, 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, 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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