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Aetna Medicare Core II (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Core II (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 II (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Core II (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Los Angeles and Orange 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 II (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 II (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 II (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.00. 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 $6200.00 (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 $6200.00 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 II (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 where you purchase the drug. For example, you'll pay no copay for preferred generic drugs at a preferred pharmacy or through the preferred mail-order service. However, you will pay 22% coinsurance for standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. 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 II (PPO) plan offers comprehensive coverage with a range of benefits. You can expect no copays for primary care visits, hearing exams, vision exams, and many dental services. This plan covers inpatient hospital stays, outpatient services, emergency services, and various therapies. It also includes coverage for hearing aids, vision eyewear, and dental services, with some services requiring copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $300 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute, and a $375 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute is 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 are covered by the Aetna Medicare Core II (PPO) plan, including outpatient hospital services with a copay between $0 and $425, observation services with a $300 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. The plan also waives the three-pint deductible for outpatient blood services.
Partial Hospitalization See details
Aetna Medicare Core II (PPO) covers partial hospitalization 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 II (PPO) plan. Ground ambulance services have a copay of $265, 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 II (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $265 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Core II (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $35 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $35, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, additional preventive services, kidney disease education services with 20% coinsurance, and other preventive services. Other services covered include health education, wigs for hair loss related to chemotherapy, additional sessions for smoking and tobacco cessation counseling, fitness benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit with no copay. In-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, counseling services, and weight management programs are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay for up to 1 visit per year. Prescription hearing aids (all types) have no copay for up to 2 visits per year, and the plan covers up to $1,250 per year for both in-network and out-of-network services. The plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear, or OTC hearing aids.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams and eyewear have no copay, and eyewear has a combined maximum benefit of $100 per year.
Dental Services See details
Dental services are covered, 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, all with no copay. Orthodontic services and other dental services have a $1,500 annual maximum, and 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 a coinsurance between 0% and 20%. Prior authorization is required for all services.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%, and prior authorization is required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under the Aetna Medicare Core II (PPO) plan. DME has a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $40, Lab Services have no copay, and Diagnostic Radiological Services have a copay up to $295. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Core II (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the Aetna Medicare Core II (PPO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Core II (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other services are partially covered under the Aetna Medicare Core II (PPO) plan, but acupuncture, over-the-counter items, and meal benefits are not covered. Other 1 and Other 2 have no copay, and include services such as annual wellness exams, screening mammography, gFOBT, and FIT.
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