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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 Western KS: Saline and surrounding counties. 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 $10100.00 (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 $10100.00 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 Core (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and where you fill your prescription. For preferred generic drugs, you will pay no copay at preferred pharmacies or mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance depending on the tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Core (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. It also provides benefits for primary care, preventive services, hearing, vision, and dental care, often with no copay. Additional benefits include coverage for ambulance services, home health services, and home infusion. This plan includes a range of cost-sharing options. Some services have copays, such as specialist visits, therapies, and ambulance services. Other services, like inpatient hospital stays, have copays for the first few days before coverage kicks in. Medical equipment and certain drugs have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Aetna Medicare Core (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $395 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $335 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute is covered, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $275, observation services with a $395 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $35 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Core (PPO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $300 copay, and air ambulance services have 20% coinsurance, while 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 Aetna Medicare Core (PPO). Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $125 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Core (PPO) plan covers primary care physician services with no copay, and also covers chiropractic services with a $20 copay. Occupational therapy services have a $35 copay, and physical therapy and speech-language pathology services have a $35 copay. The plan also covers specialist services with a copay between $0 and $35.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero-dollar services, annual physical exams with no copay, and additional preventive services, including health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and kidney disease education services. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits also have no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids are covered up to $1500 per year. OTC Hearing Aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision services with the Aetna Medicare Core (PPO) plan includes eye exams, routine eye exams, and other eye exam services with no copay. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay and a combined maximum benefit of $150 per year.
Dental Services See details
The Aetna Medicare Core (PPO) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $35 copay for Medicare Dental Services. The plan has a maximum benefit of $1000 per year for in and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Core (PPO) plan, with prior authorization required. 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 prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Core (PPO), including Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment with coinsurance; however, Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
For Aetna Medicare Core (PPO), diagnostic and radiological services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $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, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Core (PPO) plan. While the plan does offer cardiac rehabilitation services, including intensive cardiac rehabilitation services, pulmonary rehabilitation services, and SET for PAD services, none of these are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Core (PPO), with a copay of $10 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF 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, and also covers over-the-counter (OTC) items with no copay, up to a maximum of $45 every three months. This plan also covers a meal benefit with no copay, as well as other services like annual wellness exams and screening mammography, and gFOBT/FIT, all with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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