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Aetna Medicare Freedom Core (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Freedom 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 Freedom Core (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Freedom Core (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Austin. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Freedom 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 Freedom 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 Freedom 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 Freedom Core (PPO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a 22% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Aetna Medicare Freedom Core (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the service. You'll find no copays for many services, such as primary care visits, routine hearing exams, eye exams, and dental cleanings, along with coverage for ambulance, emergency services, and home health services. The plan also covers preventive services with no copays for annual physical exams and several additional preventive services, alongside coverage for hearing aids, vision and dental services. However, it's important to note that certain services like cardiac rehabilitation, routine chiropractic care, and certain dental procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $425 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered under the Aetna Medicare Freedom Core (PPO) plan. Outpatient hospital services have a copay between $0 and $300, and observation services have a copay of $395; Ambulatory Surgical Center (ASC) Services, and outpatient blood services have no copay. Outpatient substance abuse services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Freedom Core (PPO) plan with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Freedom Core (PPO) plan, including both ground and air ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed and worldwide emergency services, are covered by the Aetna Medicare Freedom Core (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Worldwide Emergency Transportation has a $250 copay, and Urgently Needed Services has a $55 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Freedom Core (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a copay between $0 and $40, mental health specialty services with a $40 copay, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $55, and opioid treatment program services with a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services with a copay. Kidney Disease Education Services have a 20% coinsurance, and the following additional preventive services have no copay: Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $35 copay, routine hearing exams are covered for 1 visit per year with no copay, and fitting/evaluation for hearing aids are covered for 1 visit per year with no copay. Prescription hearing aids are covered up to $500 per ear, and prescription hearing aids (all types) are covered for 2 visits per year with no copay; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by the Aetna Medicare Freedom Core (PPO) plan, including eye exams with no copay and eyewear with no copay, and a combined maximum of $150 per year for both in-network and out-of-network services. Routine eye exams are limited to one per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, dental x-rays with no copay, prophylaxis (cleaning) with no copay, and orthodontic services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative services, adjunctive general services, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%, and endodontics is covered with 20% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but 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 Freedom Core (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has no copay and a coinsurance between 0% and 20%, while Prosthetic Devices have a 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for Medicare-covered diagnostic procedures, tests, and lab services. Lab services have no copay, and Diagnostic Radiological Services have a copay of at most $250, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Freedom Core (PPO) plan with no copay and no coinsurance, but 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 Freedom Core (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Freedom Core (PPO) plan, but prior authorization is required. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Freedom Core (PPO) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $45 every three months. Other services such as Acupuncture, Meal Benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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