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Aetna Medicare Core Elite (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Core Elite (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 Elite (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Core Elite (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Northeast California. The overall rating for this plan is not yet available for 2025.
It's important to know that Aetna Medicare Core Elite (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 Elite (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 Elite (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 has a $550.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $8950.00 (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 $8950.00 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 Elite (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail order. Standard generic drugs have 24% coinsurance, and preferred brand drugs have 25% coinsurance, regardless of the pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Core Elite (PPO) plan offers a variety of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. This plan also covers primary care, preventive services, hearing, vision, dental, and home health services, often with no copay or a low copay. Additionally, it provides coverage for emergency services, ambulance services, and home infusion services. The plan includes coverage for durable medical equipment, diagnostic and radiological services, and skilled nursing facility stays. However, some services like cardiac rehabilitation, certain types of hearing aids, and specific dental and vision services may not be covered or have limitations. Always review the specific details for any service you need.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but require prior authorization. For Inpatient Hospital-Acute, you pay a $285 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you pay a $285 copay for days 1-6, and no copay for days 7-90. Additional days and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay between $0 and $285, observation services with a $285 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 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 Elite (PPO) plan with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Core Elite (PPO) plan, with a $285 copay for ground ambulance services and a 20% coinsurance for air ambulance services. 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 under the Aetna Medicare Core Elite (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Transportation has a $285 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Core Elite (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $30 copay. Physician specialist services have a copay between $0 and $30, and physical therapy and speech-language pathology services have a $30 copay. Individual and group sessions for mental health and psychiatric services, as well as opioid treatment program services, have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Other Health Care Professional services have a copay between $0 and $30. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Core Elite (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services may have a copay, and the plan also covers kidney disease education services with a 20% coinsurance. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing exams are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per year, and all types of prescription hearing aids are covered with no copay. However, OTC hearing aids, and prescription hearing aids for the inner or outer ear are not covered.
Vision Services See details
Vision services, including routine eye exams, other eye exam services, and eyewear, are covered under the Aetna Medicare Core Elite (PPO) plan. There is no copay for eye exams, routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum of $75 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Core Elite (PPO) plan covers Medicare Dental Services with a $40 copay, and also covers 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 with no copay. Other dental services have a maximum plan benefit of $750 per year. Orthodontic Services and Orthodontics are not covered, while Maxillofacial Prosthetics and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Core Elite (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, and 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 Elite (PPO) plan, but require Prior Authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Core Elite (PPO) plan covers Durable Medical Equipment with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, with coinsurance for Medicare-covered shoes and inserts, and copays for Medicare-covered supplies; Diabetic Supplies have 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services with no copay, diagnostic radiological services with a copay of at most $200, therapeutic radiological services with coinsurance of at most 20%, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core Elite (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 Core Elite (PPO) plan. While the plan covers the benefit in general, none of the specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Core Elite (PPO) plan, but require prior authorization. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $150 per day. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items and other services. Over-the-counter items have no copay, and other services include annual wellness exams, screening mammography, gFOBT, and FIT, all of which have no copay. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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