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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 2026, 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 2026.
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 $5.30. 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 $615.00 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 offers an enhanced alternative drug benefit with a $615.00 annual prescription drug deductible. During the initial coverage phase, Tier 1 preferred generic drugs have no copay when using a preferred pharmacy or preferred mail order, and a $12.00 copay at standard locations. Other tiers require coinsurance, including 22% for Tier 2 standard generics and 25% for both Tier 3 preferred brand and Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs. Additionally, beneficiaries who qualify for the low-income subsidy can receive a premium reduction and pay $5.30 for Part D.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan provides robust medical coverage, featuring no copays for primary care visits, specialist consultations, and home health services. For inpatient hospital stays, members pay a $175 daily copay for the first five days and no copay for days six through ninety, while emergency room visits carry a $150 copay. Outpatient care, diagnostic testing, and routine lab services are highly affordable, often requiring no copay or low copays up to $175 depending on the procedure. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing exams with no copays, along with annual allowances of $1,250 per ear for hearing aids and $250 for eyewear. Additionally, members benefit from no copays on medical equipment and up to twelve free one-way transportation trips per year, plus a $60 quarterly over-the-counter item allowance. Most other services, including dialysis and durable medical equipment, feature no copays and a standard coinsurance of up to 20 percent.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by Aetna Medicare Value Plus (HMO-POS), requiring a $175 daily copay for days 1 to 5, no copay for days 6 to 90, and no coinsurance for both acute and psychiatric stays. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (HMO-POS) covers outpatient services with no coinsurance, featuring no copay to a $175 copay for outpatient hospital care, a $175 copay per stay for observation services, and a $125 copay for ambulatory surgical center visits. Outpatient substance abuse sessions and blood services are covered with no copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO-POS) covers partial hospitalization benefits with copays ranging from no copay to $180, and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Value Plus (HMO-POS), as transportation to any health-related location is not covered. Ground ambulance services require a $250 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and plan-approved transportation is covered with no copay or coinsurance for up to 12 one-way trips per year.
Emergency Services See details
Emergency services are covered under the Aetna Medicare Value Plus (HMO-POS) plan with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with copays ranging from $150 to $250 and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered under the Aetna Medicare Value Plus (HMO-POS) plan, as podiatry services are not covered. Most covered services, such as primary care visits, specialist consultations, and physical therapy, feature no copay or coinsurance, while additional telehealth benefits require a $0 to $10 copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (HMO-POS), offering annual physical exams, health education, and glaucoma screenings with no copay and no coinsurance, while kidney disease education requires a 20% coinsurance and no copay. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, and weight management programs.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (HMO-POS), featuring annual routine exams and fitting evaluations with no copay and no coinsurance. Up to $1,250 per ear is provided annually for covered prescription hearing aids with no copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (HMO-POS) covers vision services with no copay and no coinsurance, including one routine eye exam per year and follow-up diabetic eye exams. Eyewear, including contacts, lenses, frames, and upgrades, is also covered with no copay or coinsurance up to a combined maximum of $250 annually.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO-POS), offering no copay and no coinsurance for Medicare dental services, oral exams, cleanings, and x-rays. Other covered services require no copay and a 20% to 50% coinsurance up to a $1,000 annual limit, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (HMO-POS) covers home infusion bundled services, which require prior authorization and may involve step therapy. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Value Plus (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under Aetna Medicare Value Plus (HMO-POS), featuring no copays for all items and coinsurance ranging from 0% to 20% depending on the service. Covered benefits include durable medical equipment, prosthetic devices, medical supplies, and diabetic equipment, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Aetna Medicare Value Plus (HMO-POS) covers diagnostic and radiological services with no coinsurance. Members pay no copay for lab services, outpatient X-rays, diagnostic tests, and diagnostic radiological services, while therapeutic radiological services require a $60 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (HMO-POS) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (HMO-POS) indicates that some services are covered for Cardiac Rehabilitation, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Since these specific services are not covered, there are no active copayments or coinsurance costs associated with them.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Aetna Medicare Value Plus (HMO-POS) with prior authorization, featuring no copay or coinsurance for days 1 through 20 and a $50 daily copay with no coinsurance for days 21 through 100. This benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO-POS) partially covers other services with no copay and no coinsurance for covered benefits, including unlimited acupuncture, select wellness screenings, and up to $60 every three months for over-the-counter items. However, meal benefits and dual eligible SNP services are not covered.
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