A non-government entity
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 Santa Barbara 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 $56.00. 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:
Sign up for Aetna Medicare Core (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies. In the initial coverage phase, you will pay either a copay or coinsurance for your prescriptions until your total drug costs reach $2,000. Once you reach this amount, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Core (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, with no copay for the remaining days. Outpatient services, primary care, preventive services, hearing, vision, and dental services often have no copay, while other services like ambulance, emergency care, and specialist visits have copays ranging from $20 to $445. The plan also covers services such as partial hospitalization, home health, and skilled nursing facilities, with specific copays or coinsurance amounts. Additionally, this plan provides coverage for prescription hearing aids, and has a maximum benefit for dental services. Other services like OTC items are covered up to a certain amount.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Core (PPO) plan. For Inpatient Hospital-Acute, you'll pay a $445 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $380 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0-$425, observation services with a copay of $445, 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 (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 Aetna Medicare Core (PPO). Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services under the Aetna Medicare Core (PPO) plan include a $125 copay for emergency services and worldwide emergency coverage, a $40 copay for urgently needed services, and a $295 copay for worldwide emergency transportation. There is no coinsurance for these services.
Primary Care See details
The Aetna Medicare Core (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $40 copay, and physician specialist services with a $35 copay. The plan also covers mental health and psychiatric services, as well as physical therapy and speech-language pathology services with a $40 copay. Other health care professional services have a copay between $0 and $35. Additionally, additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services such as health education, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, wigs for hair loss related to chemotherapy, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit with no copay. Kidney Disease Education Services have a 20% coinsurance. Some services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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 exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $1250 per ear every 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
The Aetna Medicare Core (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $75 per year.
Dental Services See details
The Aetna Medicare Core (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. Medicare dental services have a $40 copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $750 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Core (PPO) plan, but require prior authorization. The plan has a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, and Prosthetic Devices have a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $40, and lab services with no copay. Radiological services are also covered, with a copay of up to $295 for diagnostic services, a 20% coinsurance for therapeutic services, and a $40 copay for outpatient X-ray services.
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, but the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some services, but the details are not available.
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, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Core (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $30 every three months, as well as other services including annual wellness exams and screening mammography with no copay. Acupuncture, meal benefits, and many other services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved