A non-government entity
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 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 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:
Sign up for Aetna Medicare Core II (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 II (PPO) plan has an enhanced alternative drug benefit. You must first satisfy a deductible of $590.00 before your drug coverage begins. Once the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, and 22% coinsurance for standard generic drugs. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you pay nothing for your covered drugs.
Additional Benefits
The Aetna Medicare Core II (PPO) plan offers comprehensive coverage with a variety of benefits. The plan provides coverage for inpatient hospital stays, outpatient services, and emergency services with varying copays depending on the specific service. Additional benefits include coverage for primary care, preventive services, hearing, vision, dental, and home health services, often with no copay or low copays. This plan also covers specialized services like partial hospitalization, ambulance services, and skilled nursing facility stays, each with its own cost-sharing structure. The plan provides coverage for medical equipment, diagnostic and radiological services, and home infusion services. The plan has some exclusions, such as acupuncture, over-the-counter items, and meal benefits.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you'll pay a $375 copay 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, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $425, Observation Services with a $300 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Core II (PPO) plan and requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Core II (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $265, 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 by the Aetna Medicare Core II (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Worldwide Emergency Transportation has a $265 copay, and Urgently Needed Services has a $40 copay.
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, and mental health specialty services with a $40 copay. The plan also covers other health care professionals with a copay between $0 and $35, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams, Routine Hearing Exams, and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids are covered up to $1250 per ear per year, with a maximum of two visits per year, and no copay for Prescription Hearing Aids (all types). Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered with no copay. Routine eye exams are limited to one per year, 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 treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Medicare Dental Services have a $40 copay and require prior authorization, and orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,500 annual maximum for these services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Core II (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Core II (PPO) plan, but require prior authorization. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Aetna Medicare Core II (PPO) plan covers Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetic Devices and Medical Supplies with no copay and 0-20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home. Diabetic Supplies have 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $40, while Lab Services have no copay. 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, though additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Core II (PPO) plan. However, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Core II (PPO) plan with prior authorization required. You will pay a copay of $10 for days 1-20 and $214 for days 21-100.
Other Services See details
The Aetna Medicare Core II (PPO) plan does not cover acupuncture, over-the-counter items, or meal benefits. Other services are covered, including annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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