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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 Northern California. 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 $46.00. 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 $8700.00 (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 $8700.00 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 the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay no copay at preferred pharmacies and $12 at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 22% or 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 II (PPO) plan offers a wide range of benefits with varying cost-sharing structures. Inpatient hospital stays have a $375 copay for the first six days, with no copay for subsequent days, and outpatient services have copays ranging from $0 to $400. Primary care visits, preventive services, vision exams, and many dental services are available with no copay. The plan also includes coverage for ambulance services, emergency services, and mental health services, with specific copays for each. Diagnostic and radiological services, skilled nursing facilities, and home health services are covered, with some services requiring prior authorization or coinsurance. Additionally, the plan covers hearing exams, with a maximum benefit for prescription hearing aids.
Inpatient Hospital See details
The Aetna Medicare Core II (PPO) plan covers inpatient hospital stays, including acute and psychiatric care, with a copay of $375 for days 1-6 and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered, with copays ranging from $0 to $400. Observation Services have a $375 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services are covered with a $40 copay for both individual and group sessions, and Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Aetna Medicare Core II (PPO) 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 $285 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 by the Aetna Medicare Core II (PPO) plan. Emergency Services and Worldwide Emergency Coverage and Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation has a $285 copay. Urgently Needed Services have a $40 copay. There is no coinsurance for any of these services.
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 with a $30 copay, and physician specialist services with a $30 copay. The plan also covers mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a copay from $0 to $30, psychiatric services with a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay from $0 to $40. Opioid Treatment Program Services are covered with a $40 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Core II (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay; prescription hearing aids have a maximum plan benefit coverage of $1250 per ear every year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Core II (PPO) plan covers vision services, including eye exams and eyewear, with no copay. Routine eye exams are limited to one per year, and eyewear has a combined maximum benefit of $75 per year.
Dental Services See details
Dental services are covered, with a $1,500 annual maximum benefit for both in-network and out-of-network services. 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 have no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Core II (PPO) plan 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, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Core II (PPO) plan covers Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetic Devices, Diabetic Supplies, and Medical Supplies with 0% to 20% coinsurance, as well as Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $250, Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have no 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. 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 II (PPO) plan, but the plan does not cover any specific services. There is a copay for the services, but the exact amount is not specified in the provided information.
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. The plan has a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Aetna Medicare Core II (PPO) covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $30 every three months. Acupuncture, 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. Other 1 and Other 2 services are covered with no copay.
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