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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 Kern, Riverside and San Bernardino Counties. This plan received an overall rating of 4.5 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 $8900.00 (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 $8900.00 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. For preferred generic drugs, you'll have no copay at preferred pharmacies or mail order, and a $12 copay at standard pharmacies. Standard generic drugs have 24% coinsurance, while preferred and non-preferred brand drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Core (PPO) plan offers coverage for a variety of services with varying costs. Inpatient hospital stays have a $350 copay for the first four days, and then no copay for the remaining days. Outpatient services, including primary care, have copays ranging from $0 to $350. This plan also includes benefits for ambulance services, with a $265 copay for ground transportation and 20% coinsurance for air ambulance. Preventive services, such as an annual physical exam, have no copay, and the plan covers hearing and dental services. Additional benefits like home infusion and durable medical equipment are covered, while some services like vision eyewear and cardiac rehabilitation are not.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you also pay a $350 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $350, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Core (PPO) plan, but requires prior authorization. You will have a $70 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Core (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $265 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Core (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
Primary Care services are covered, including Primary Care Physician Services with no copay and Chiropractic Services with a $20 copay. Occupational Therapy Services have a $40 copay, while Physician Specialist Services have a copay between $0 and $30. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services each have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Core (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services such as health education, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and kidney disease education services. The plan also covers glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit with no copay. However, in-home safety assessment, 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, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with no copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, with a limit of 1 visit per year. Prescription hearing aids are covered up to a maximum of $2000 per year, with no copay for all types of prescription hearing aids except for inner ear, outer ear, and over-the-ear hearing aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with no copay, including routine eye exams once per year, and other eye exam services, such as follow up diabetic eye exams, with no copay. Eyewear benefits are not covered, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a $40 copay for Medicare Dental Services. 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. There is a $1,000 maximum benefit per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. 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 and require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Core (PPO) plan. Durable Medical Equipment has a coinsurance of 0% to 20% and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a coinsurance of 0% to 20%. Diabetic Equipment has varying cost sharing, with Diabetic Supplies having a 0% to 20% coinsurance and Diabetic Therapeutic Shoes/Inserts having no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $40, Lab Services with no copay, Diagnostic Radiological Services with a copay of up to $295, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with a $40 copay. Prior authorization is required for all diagnostic and radiological services.
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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. This plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Core (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, with the exception of Other 1 and Other 2, which have no copay.
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