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Aetna Medicare Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Sacramento, San Joaquin and Yolo Counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Plus (HMO-POS) 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 Value Plus (HMO-POS).
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 Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.50. 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 $250.00 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 Maximum Out-Of-Pocket cost of $2000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Value Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a $250 deductible. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with varying copays, and no copays for partial hospitalization. This plan also provides coverage for ambulance and transportation services, emergency services, and primary care services, including mental health and chiropractic services, with no copays for many services. Additional benefits include preventive, hearing, vision, and dental services, as well as home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has a $100 copay for days 1-5 and no copay for days 6-90. 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 are covered, including outpatient hospital services with a copay between $0 and $50, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for some outpatient services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (HMO-POS), with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location have no copay and are limited to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Emergency Services has a $140 copay and no coinsurance, Urgently Needed Services has a $10 copay and no coinsurance, and Worldwide Emergency Services has varying copays: $140 for Worldwide Emergency and Urgent Coverage, and $250 for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy, speech-language pathology, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, individual and group sessions for mental health and psychiatric services, physical therapy, and speech-language pathology services have no copay. Occupational therapy, additional telehealth benefits, and opioid treatment program services have a copay that may vary. Additional telehealth benefits have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services that may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include a copay for Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, however there is no copay for these services.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay, but prescription hearing aids are only covered up to a maximum of $1250 per year. Prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. The plan offers an annual combined maximum of $350 for eyewear.
Dental Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers a variety of dental services with a $1,500 annual maximum, including oral exams, dental x-rays, other diagnostic services, cleanings, fluoride treatments, other preventive services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Orthodontic services are covered under diagnostic and preventive dental. 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 under the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Value Plus (HMO-POS) plan, including Durable Medical Equipment with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with no coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with no copay, therapeutic radiological services with a copay of up to $60, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan with no copay and no coinsurance, though Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (HMO-POS) plan. A doctor referral is required for this benefit, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, with a $0 copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers acupuncture with no copay, and over-the-counter items with no copay and a maximum benefit of $75 every three months. Annual wellness exams and screening mammography, and gFOBT/FIT are covered with no copay, while meal benefits, 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, 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, Self-Directed Personal Assistance Services are not covered.
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