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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 Colusa, Glenn, Lake, Shasta and Trinity Counties. 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. Once the deductible is met, you will pay a copay or coinsurance for your drugs. For preferred generic drugs, you will have no copay at preferred pharmacies or preferred mail order. Standard generic drugs have 24% coinsurance. Preferred and non-preferred brand drugs have 25% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Core Elite (PPO) plan offers a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services with copays ranging from $0 to $285, and some services with coinsurance. Preventive, hearing, vision, and dental services have no copay, while other services like home health and skilled nursing facilities have copays.
Inpatient Hospital See details
The Aetna Medicare Core Elite (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For days 1-6, there is a $285 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services with the Aetna Medicare Core Elite (PPO) plan cover outpatient hospital services with a copay between $0 and $285, observation services with a $285 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Core Elite (PPO) plan with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Core Elite (PPO) plan. Ground ambulance services have a copay of $285, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations 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 have a $125 copay and no coinsurance, Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Services have varying copays depending on the specific service. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $285 copay.
Primary Care See details
The Aetna Medicare Core Elite (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a copay between $0 and $30. Mental health specialty services, psychiatric services, and Opioid Treatment Program Services are covered, each with a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services, including Medicare-covered zero-dollar services, are covered. Annual physical exams have no copay, while Kidney Disease Education Services have a 20% coinsurance. Other services like Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, Wigs for Hair Loss Related to Chemotherapy, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, have no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to $1,250 per year, per ear with no copay for prescription hearing aids of all types. However, prescription hearing aids for the inner ear, outer ear, or over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Core Elite (PPO) plan covers vision services, including eye exams and eyewear. 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 plan benefit of $75 per year.
Dental Services See details
The Aetna Medicare Core Elite (PPO) plan covers 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 with no copay, but has a $750 annual maximum. Medicare dental services have a $40 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Core Elite (PPO) plan, requiring 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 by the Aetna Medicare Core Elite (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. 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, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic Radiological Services have a copay of up to $200, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core Elite (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 covered, but the plan does not cover any of the sub-services. The cost sharing includes a copay, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Core Elite (PPO) plan, with a $10 copay for days 1-20 and a $150 copay 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
Other Services in the Aetna Medicare Core Elite (PPO) plan covers over-the-counter items and other services with no copay. Acupuncture, meal benefits, 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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