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Aetna Medicare Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Core (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Core (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Core (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wichita Kansas Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Core (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 Core (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 Core (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 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 $5750.00 (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 $5750.00 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:
Sign up for Aetna Medicare Core (PPO)
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Drug Coverage
The Aetna Medicare Core (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier. For preferred generic drugs, you'll pay no copay at preferred pharmacies and mail order, and $12 at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Core (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, while outpatient services often have no copay. The plan also provides coverage for a range of services, including primary care, preventive services, hearing, vision, and dental, with copays and coinsurance depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $295 for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for Aetna Medicare Core (PPO) includes coverage for all outpatient hospital services and observation services with copays ranging from $0 to $295, as well as Ambulatory Surgical Center (ASC) services with no copay. This plan also covers outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Core (PPO) plan, and requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $280 copay, and air ambulance services with 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 Core (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $280 copay. There is no coinsurance for any of these services.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $25, Mental Health Specialty Services with a $25 copay for individual and group sessions, Podiatry Services with a $25 copay, Other Health Care Professional with a copay between $0 and $25, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $25, and Opioid Treatment Program Services with a $25 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Aetna Medicare Core (PPO) covers preventive services, including an annual physical exam with no copay, and additional preventive services with varying copays. Kidney disease education services are covered with 20% coinsurance, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1500 per year, and prescription hearing aids (all types) have no copay. OTC hearing aids are not covered, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams, and other eye exam services. Eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay, and a combined maximum of $280 per year.
Dental Services See details
The Aetna Medicare Core (PPO) plan covers Medicare Dental Services with a $25 copay, and other dental services, including 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, all with no copay. Orthodontic Services are covered under Diagnostic and Preventive Dental, but Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The maximum plan benefit coverage is $2000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. 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 under the Aetna Medicare Core (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Core (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Core (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $160, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core (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 Core (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Core (PPO) plan. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Core (PPO) plan covers acupuncture with a $20 copay for up to 12 treatments per year. Over-the-counter items are covered with no copay, up to a maximum of $50 every three months, and the plan provides Nicotine Replacement Therapy (NRT) and Naloxone coverage. The plan also covers meal benefits with no copay, and other services such as annual wellness exams, screening mammography, gFOBT, and FIT with no copay. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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