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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 Humbodlt and Siskiyou 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 $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 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 $590.00. In the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies or mail order. Standard generic drugs have a 24% coinsurance, and preferred and non-preferred brand drugs have a 25% coinsurance.
Additional Benefits
The Aetna Medicare Core Elite (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes inpatient and outpatient services, with varying copays depending on the service. You'll also find coverage for preventive, hearing, vision, and dental services, often with no copay, along with coverage for medical equipment and home health services.
Inpatient Hospital See details
The Aetna Medicare Core Elite (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $315 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 stays and upgrades for inpatient hospital-acute are not covered. Inpatient hospital psychiatric benefits are also covered, with the same cost-sharing structure as inpatient hospital stays, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Core Elite (PPO) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $315, observation services have a $315 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $40, 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. Ground ambulance services have a $285 copay, while air ambulance services have a 20% coinsurance, and 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 has a $40 copay, and Worldwide Emergency Transportation has a $285 copay, with no coinsurance for any of these services.
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, and occupational therapy services with a $30 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. In addition, the plan offers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40, and physician specialist services with a copay between $0 and $30.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional 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. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per ear every year, and the plan does not cover OTC hearing aids, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, or Prescription Hearing Aids - Over the Ear.
Vision Services See details
The Aetna Medicare Core Elite (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $170 per year.
Dental Services See details
The Aetna Medicare Core Elite (PPO) plan covers dental services with a $750 annual maximum. Medicare dental services have a $40 copay, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Core Elite (PPO) plan covers medical equipment, including durable medical equipment with no copay and 0-20% coinsurance, and prosthetic devices with 20% coinsurance. Diabetic equipment is covered with coinsurance for Medicare-covered therapeutic shoes or inserts and a copay for Medicare-covered diabetes supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
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. Although the plan covers Cardiac Rehabilitation Services, none of the sub-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, and for days 21-100, the copay is $150. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items and Other 1 and 2 services, all with no copay; however, 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. The OTC items have a maximum plan benefit coverage amount of $30.00 every three months.
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