Aetna Medicare Elite Plan (PPO)

The Aetna Medicare Elite Plan for 2025 extends beyond the baseline of Original Medicare, offering enhanced benefits like prescription drug coverage and access to a national provider network.

This straightforward overview will clarify the Elite Plan’s features, ratings, and cost structure, equipping you with the information you need to assess its relevance to your healthcare needs.


Key Takeaways

  • The Aetna Medicare Elite Plan provides comprehensive healthcare coverage including prescription drugs, mental health services, and additional benefits like dental, vision, and hearing, with a government quality rating of 4.0 out of 5 stars for 2024.


  • Cost management is facilitated with an affordable monthly premium of $30.00, cost-sharing for services, and strategies for minimizing out-of-pocket expenses, while the plan’s network includes a wide range of in-network providers and coverage for out-of-network care.


  • Members have access to extensive resources for plan management, including the Aetna Medicare website and customer service, and can enroll through multiple channels during designated enrollment periods, provided they meet age, disability, and income criteria.

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Exploring the Aetna Medicare Elite Plan

The Aetna Medicare Elite Plan stands out from ordinary Aetna Medicare plans. It is a health plan designed to cater to a broad range of healthcare needs, offering an array of benefits and services that go beyond the scope of Original Medicare.

With a high plan rating influenced by factors such as patient safety, member experience, and other relevant considerations, this Aetna Medicare plan is a testament to Aetna’s commitment to providing quality healthcare.

Beyond Original Medicare, the Aetna Medicare Elite Plan provides supplementary benefits including prescription drug coverage – a significant boon for members relying on regular medications.


Understanding Plan Ratings

The ratings of a plan significantly sway your decision when selecting a Medicare plan. But why are these ratings so important? Plan ratings, such as the Star Ratings system, provide invaluable insights into the quality of care and customer service offered by the plans.

Medicare evaluates plans based on these ratings, ensuring that you make an informed decision.

For instance, the Aetna Medicare Elite Plan boasts an impressive overall government quality rating of 4.0 stars out of 5 stars for 2024, testifying to its exceptional service and performance. These ratings facilitate comparisons between different plans, ensuring that you make a well-informed decision about your healthcare.


Key Features at a Glance


Aetna medicare advantage plans The Aetna Medicare Elite Plan sets itself apart with its comprehensive coverage. Its offerings range from essential healthcare services to medical supplies and durable medical equipment, ensuring that all your health needs are met.


But that’s not all. The plan also includes benefits such as dental, vision, and hearing coverage, providing a holistic approach to your wellbeing.

The plan offers nationwide coverage, meaning you can access services across the country, though it’s worth noting that to stay out of network may result in higher costs for certain services.

Essential Coverage Details

Grasping the specifics of your health plan’s coverage can vastly improve the management of your healthcare needs. The Aetna Medicare Elite Plan offers broad coverage for mental health services, including inpatient hospital stays for psychiatric conditions and outpatient therapy visits, both group and individual, with or without a psychiatrist.


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Moreover, the plan also covers foot care examinations and treatments, although it is crucial to note that routine foot care, falling under podiatry services, is not included in the coverage.


Inpatient and Outpatient Services

The Aetna Medicare Elite Plan ensures comprehensive coverage for your healthcare needs. Whether you require inpatient or outpatient services, the plan has got you covered. For inpatient hospital stays, the plan imposes an in-network cost of $795 per stay.

If you opt for out-of-network facilities, you are accountable for $500 per day for days 1 through 20 and no charges for days 21 through 90.

Similarly, outpatient hospital visits incur an in-network copay ranging from $0 to $395 per visit, while out-of-network services are subject to a 30% coinsurance per visit. The plan also imposes cost-sharing amounts for various outpatient services such as X-rays, CT scans, and chiropractic services, ensuring that you can manage your healthcare expenses effectively.


Prescription Drug Benefits

A standout feature of the Aetna Medicare Elite Plan is its comprehensive prescription drug coverage. Once the coverage gap is reached, members are required to pay 25% for both generic and brand-name drugs, making it easier to manage drug pricing.

To be eligible for these prescription drug benefits, individuals must be enrolled in a prescription drug plan, such as Medicare Part A and/or Medicare Part B, ensuring that all members can access the medications they need without breaking the bank.


Extra Benefits and Wellness Programs

Beyond essential healthcare services, the Aetna Medicare Elite Plan includes additional benefits and wellness programs. These include:


  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Concierge services
  • Fitness programs


This provides you with a comprehensive healthcare package that caters to all aspects of your wellbeing.

From gym memberships to the SilverSneakers® fitness programs, the plan offers a variety of wellness programs designed to keep you healthy and active.

Network and Providers

The effectiveness of your health plan hinges on the quality of providers in its network. The Aetna Medicare Elite Plan boasts an extensive network of providers, ensuring that you can access quality healthcare services when you need them.


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Whether you’re selecting a primary care physician or seeking a referral to a specialist, the plan offers you the flexibility and support you need to manage your healthcare efficiently.


Choosing Your Primary Care Physician

Choosing a primary care physician is a pivotal step towards effective healthcare management. Your primary care physician serves as your main healthcare provider, offering initial care and guiding you through the healthcare system.

With the Aetna Medicare Elite Plan, you can choose your primary care physician by contacting Member Services or accessing the secure Member Portal. The plan also allows you to change your primary care physician at any time, ensuring that you always have a healthcare provider that meets your needs.


Specialist and Hospital Networks

Be it a specialist consultation or hospital care, the Aetna Medicare Elite Plan has you covered. The plan’s specialist and hospital networks are extensive, giving you access to a wide range of healthcare professionals and facilities.

Even if you need care from out-of-network specialists or hospitals, the plan provides coverage, ensuring that you can get the care you need, when you need it.

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Cost Considerations

Medicare Advantage plans for 2025 may have changed slightly from previous years, so it’s always a good idea to compare plans and benefits in your area each year. Plans may differ greatly depending on the insurance company and your area.


Medicare Advantage Plan Networks

Medicare Advantage plans use networks with their coverage. The coverage rules vary by the type of Medicare Advantage plan you’re enrolled in.


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Medicare Advantage plans must provide coverage that at least matches what Medicare Part A and Medicare B cover. Many plans may include additional benefits though.

Member Resources and Support

Access to the right resources is key to effective healthcare management. The Aetna Medicare Elite Plan provides a wealth of resources and support to its members, including an array of tools and features on the Aetna Medicare website as well as online plan management capabilities.


Utilizing the Aetna Medicare Website

The Aetna Medicare website offers a variety of features and resources, including:


  • Printing new ID cards
  • Searching for doctors and hospitals
  • Viewing claims
  • Accessing online health tools
  • Finding detailed information about your benefits and coverage through the member portal.


Member ID Card and Customer Service

Your member ID card is your passport to healthcare services, and customer service is your guide. With the Aetna Medicare Elite Plan, you can access essential details about your coverage and get assistance with your plan whenever you need it, including accessing your plan documents.

Whether you have questions about your Medicare plan or need help understanding your benefits, the plan’s customer service is ready to assist you.

Enrollment and Eligibility

Ready to enroll in the Aetna Medicare Elite Plan? This section will guide you through the enrollment process and help you determine your eligibility. From age and disability criteria to income restrictions, we’ve got all the information you need to make an informed decision.


Steps to Enroll

The process to enroll in the Aetna Medicare Elite Plan is quite simple. You can contact a licensed agent, request a paper enrollment form, or even enroll online.


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Plus, with the annual enrollment period from January 1 to March 31 and the annual election period from October 15 to December 7, you have multiple opportunities to join the plan.


Eligibility Criteria

To be eligible for the Aetna Medicare Elite Plan, you must meet certain criteria:


  • You must be 65 years of age or older or have a qualifying disability.
  • There are also income restrictions, with a couple qualifying with a combined income of $1,992 per month.
  • Pre-existing conditions are not a barrier to eligibility for this plan.

Making the Most of Your Plan

Upon enrollment in the Aetna Medicare Elite Plan, it’s time to utilize its benefits to the fullest. From leveraging the plan’s diverse benefits to reducing out-of-pocket expenses and staying informed about plan updates, there are several strategies you can employ to maximize your plan’s benefits.


Maximizing Covered Services

It’s vital to leverage the extensive range of services covered by the Aetna Medicare Elite Plan. Whether you’re making use of the plan’s dental, vision, and hearing coverage or taking advantage of its gym memberships and wellness programs, there are plenty of ways to optimize your benefits.

Plus, by monitoring your dental service benefit maximum and exploring mail-order prescription options, you can further enhance your benefits utilization.


Staying Informed on Plan Updates

Keeping up-to-date with modifications and updates is crucial to fully benefit from your Aetna Medicare Elite Plan. Whether it’s through contacting Aetna for inquiries or subscribing to email updates on their website, staying informed about your plan is a key aspect of managing your healthcare.


Navigating the world of healthcare doesn’t have to be daunting. With the Aetna Medicare Elite Plan, you have a comprehensive, high-quality health plan at your fingertips.

From its robust coverage and extensive network of providers to its affordable premiums and wealth of resources and support, the plan is designed to cater to your healthcare needs and provide peace of mind. With the right plan, you can focus on what truly matters – living a healthy, fulfilling life.

Frequently Asked Questions



Is Aetna Medicare PPO the same as Medicare?

Yes, Aetna Medicare PPO provides all the benefits of Original Medicare and more because it is a Medicare Advantage plan offered by a private insurance company. It includes all benefits and services of Parts A and B and may include prescription drug coverage.


What is the payer ID for Aetna Medicare Elite?

The payer ID for Aetna Medicare Elite is #60054.


Who has the highest star rated Medicare Advantage plans?

The highest star rated Medicare Advantage plans are offered by Blue Cross Blue Shield, Humana, Aetna, UnitedHealthcare, Cigna, and Anthem. Choose from these reputable providers for quality coverage.


How do you qualify to get $144 back from Medicare?

To qualify for the $144 Medicare giveback benefit, you need to be enrolled in Medicare Parts A and B and pay your own Part B premiums. You also need to live in the service area of a plan that offers the Part B giveback.


What are the benefits of the Aetna Medicare Elite Plan?

The Aetna Medicare Elite Plan offers comprehensive coverage for inpatient and outpatient services, prescription drug benefits, and additional benefits such as dental, vision, and hearing coverage, along with access to wellness programs and gym memberships. These benefits can provide individuals with a range of healthcare services and support.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.