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Aetna Medicare Elite (PPO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$84.00
Monthly Premium
Aetna Medicare Elite (PPO) is a PPO plan offered by Aetna Inc.
Plan ID: H5521-521
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Aetna Medicare Elite (PPO) - H5521-521 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$84.00
Monthly Premium
New York Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $9250 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | Out-of-Network|$50 |
| Specialty Doctor Visit | In-Network|$0 for services provided in a nursing home|$45 for services provided outside a nursing home |
| Inpatient Hospital Care | Out-of-Network|$500 per day, days 1-5; $0 per day, days 6-90 |
| Urgent Care | Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $115 Maximum Plan Benefit of $250,000 |
| Emergency Room Visit | $115 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance Transportation | Out-of-Network|$295 |
Health Care Services and Medical Supplies
Aetna Medicare Elite (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 40% In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network|0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies|20% for other covered diabetic supplies |
| Durable Medical Equipment (DME) | Out-of-Network|40% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: Out-of-Network|40% Diagnostic Procedures: Out-of-Network|40% Imaging: Out-of-Network|40% |
| Home Health Care | Out-of-Network|40% |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: $346 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network|$45 for Mental Health - Group Sessions|$45 for Mental Health - Individual Sessions|$45 for Psychiatric Services - Group Sessions|$45 for Psychiatric Services - Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$325 all other ambulatory surgical center services |
| Outpatient Substance Abuse Care | Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 30% In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $45 Copayment for Medicare-covered Group Sessions $45 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $45 Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $60 |
| Skilled Nursing Facility Care | Out-of-Network|40% per stay |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% for x-rays||Frequencies and medical necessity requirements vary by covered dental service.||This plan does not include comprehensive dental coverage. You can purchase comprehensive dental coverage for dental services including fillings, extractions, crowns, and more through an Optional Supplemental Benefit (OSB) for an additional premium when you enroll or within 30 days of the plan's start date. See EOC for additional details on exclusions and limitations. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network||Eye Exams:|$0 for Diabetic eye exams|$45 for all other Medicare-covered eye exams|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network with an EyeMed provider||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network||Hearing Exams:|$45 for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year in or out-of-network)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0-$1,700 for hearing aids|(Maximum two hearing aids every year) |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network|$0 for all preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Elite (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|