Aetna Medicare Elite (PPO)

by Aetna Medicare

2026 Medicare Advantage plan available in Virginia

Plan ID H5521-650-0

Additional coverage:

RxHearingVisionDental

Medicare Advantage PPO 4.5 Overall

Monthly plan premium $90 / mo

Annual deductible $750 / yr

Max out-of-pocket · in-network $6,750 / yr

Drug deductible $615 / yr

4.5 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Aetna Medicare Elite (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Virginia and offered by the health insurance company Aetna Medicare. This plan's network type is PPO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Aetna Medicare Elite (PPO)

Insurance Carrier Aetna Medicare

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type PPO

Cost Summary

Aetna Medicare Elite (PPO) has a monthly premium cost of $90 per month, with an annual deductible of $750 annual deductible and a maximum out-of-pocket cost sharing of $6,750. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $90 / mo

Health portion of premium $35

Drug portion of premium $55

Annual Deductible $750 annual deductible / yr

Max Out-of-Pocket · in-network $6,750 / yr

Primary doctor visit $0 copay

Specialist visit $0-$45 copay

ER visit $130 copay

Ambulance $275 copay

Additional Benefits and Coverage

Aetna Medicare Elite (PPO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Aetna Medicare Elite (PPO) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Limited coverage

Over-the-counter drug benefits Limited coverage

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Limited coverage

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $0 copay
Out-of-network: $10 copay

Specialist visit In-network: $0-$45 copay
Out-of-network: $55 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0-$100 copay
Out-of-network: 20% coinsurance

Lab services In-network: $0 copay
Out-of-network: 20% coinsurance

Diagnostic radiology services (like MRI) In-network: $0-$375 copay
Out-of-network: 20% coinsurance

Outpatient x-rays In-network: $0-$50 copay
Out-of-network: 20% coinsurance

Emergency care $130 copay

Urgent care $40 copay

Hospital Services

Inpatient hospital coverage In-network:
  Tier 1
  $382 per day for days 1-7
  $0 per day for days 8-90
  $0 per stay
Out-of-network:
  50% per stay

Outpatient hospital coverage In-network: $0-$382 copay
Out-of-network: 50% coinsurance

Skilled nursing facility

Skilled nursing facility In-network:
  Tier 1
  $0 per day for days 1-20
  $218 per day for days 21-100
Out-of-network:
  50% per stay

Preventive services

Preventive services In-network: $0 copay
Out-of-network: 0%-50% coinsurance

Ambulance

Ground ambulance In-network: $275 copay
Out-of-network: $275 copay

Therapy services

Occupational therapy visit In-network: $30 copay
Out-of-network: 20% coinsurance

Physical therapy & speech & language therapy visit In-network: $30 copay
Out-of-network: $40 copay

Mental health services

Outpatient group therapy with a psychiatrist In-network: $45 copay
Out-of-network: 20% coinsurance

Outpatient individual therapy with a psychiatrist In-network: $45 copay
Out-of-network: 20% coinsurance

Outpatient group therapy visit In-network: $45 copay
Out-of-network: 20% coinsurance

Outpatient individual therapy visit In-network: $45 copay
Out-of-network: 20% coinsurance

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $2.00 copay $0 copay

Generic $12.00 copay $0 copay

Preferred Brand 24% coinsurance $0 copay

Non-Preferred Drug 25% coinsurance $0 copay

Specialty Tier 25% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Aetna Medicare Elite (PPO) earned an overall rating of 4.5 stars — better than Virginia's state average of 3.8 stars.

Rating category This plan State average

Overall star rating ★ 4.5 3.8

Health plan quality

Summary rating of health plan quality ★ 4.5 3.8

Staying healthy: screenings, tests & vaccines ★ 4.0 3.5

Managing chronic (long-term) conditions ★ 4.0 3.5

Member experience with health plan ★ 4.0 3.7

Member complaints & changes in performance ★ 5.0 4.0

Health plan customer service ★ 4.0 4.3

Drug plan quality

Summary rating of drug plan quality ★ 5.0 3.7

Drug plan customer service ★ 5.0 4.9

Member complaints & changes in performance ★ 5.0 3.8

Member experience with the drug plan ★ 4.0 3.6

Drug safety & accuracy of drug pricing ★ 4.0 3.5

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: $55 copay

Fitting/evaluation In-network: $0 copay
Out-of-network: $60 copay

Hearing aids - prescription In-network: $0 copay
Out-of-network: $0 copay

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance

Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance

Fluoride treatment Not covered

Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance

Comprehensive dental

Restorative services In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance

Endodontics In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Periodontics In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance

Prosthodontics, removable In-network: 50% coinsurance
Out-of-network: 70% coinsurance

Prosthodontics, fixed In-network: 50% coinsurance
Out-of-network: 70% coinsurance

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance

Orthodontics Not covered

Adjunctive general services In-network: 20%-50% coinsurance
Out-of-network: 50%-70% coinsurance

Vision

Routine eye exam In-network: $0 copay
Out-of-network: $0 copay

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay

Upgrades In-network: $0 copay
Out-of-network: $0 copay

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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