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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 San Diego County. 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 depending on the drug tier and pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order pharmacies. For standard generic drugs, you will pay 24% coinsurance, and for preferred brand drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your covered drugs.
Additional Benefits
The Aetna Medicare Core (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for the first four days, and then no copay for the rest of the stay. Outpatient services have copays that range from $0 to $350. Emergency services, urgent care, and ambulance services are also covered, but come with copays and/or coinsurance. Primary care visits, annual physical exams, and many preventive services have no copay. The plan also provides coverage for hearing and dental services, including hearing exams and routine dental cleanings with no copay. Additionally, the plan covers home health services and skilled nursing facilities, but copays apply for some services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-4, and no copay for days 5-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Core (PPO) with a $70 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, 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, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
Primary care physician services are covered with no copay, and chiropractic services are covered with a $20 copay. Occupational therapy services, physical therapy and speech-language pathology services, individual and group sessions for mental health and psychiatric services, and opioid treatment program services have a $40 copay, while physician specialist services have a copay between $0 and $30. Other health care professional services have a copay between $0 and $30. Additional telehealth benefits are covered with 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, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. The plan also covers kidney disease education services with 20% coinsurance.
Hearing Services See details
Hearing services are covered, including hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $2,000 per year, but the sub-services Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear, are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear coverage includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, but these services are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare dental services, and no copay for 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and 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 by Aetna Medicare Core (PPO) with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0% to 20% coinsurance, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, and Diabetic Equipment with varying copays and coinsurance depending on the specific service. The plan does not cover Durable Medical Equipment for use outside the home.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for Medicare-covered diagnostic procedures, tests, and lab services, and a coinsurance for Medicare-covered X-ray services. Diagnostic Procedures/Tests have a copay between $0 and $40, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $295, Therapeutic Radiological Services have at least 20% coinsurance, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core (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 by the Aetna Medicare Core (PPO) plan, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some Cardiac Rehabilitation Services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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 are not covered.
Other Services See details
Other Services include coverage for annual wellness exams and screening mammograms, as well as gFOBT and FIT, with no copay. However, acupuncture, over-the-counter items, 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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