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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 Alameda, San Francisco and San Mateo 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 $5.90. 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 $2500.00 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 a $250 deductible for prescription drugs. Once you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy and $12 at a standard pharmacy. For standard generic drugs, you pay 25% coinsurance, and for preferred brand drugs, you pay 26% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $250 copay for days 1-5, with no copay for additional days, while outpatient services can range from no copay to a $125 copay. The plan also includes no copay for preventive, vision, and dental services. This plan also covers ambulance services, with a $295 copay for ground and 20% coinsurance for air ambulance, and transportation services with no copay for up to 12 one-way trips per year. Emergency services have a $140 copay, and primary care, hearing, and home health services have no copay. Additionally, the plan covers hearing aids up to $1250 per year, and eyewear up to $325 per year.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with a $250 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $125, observation services with no 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. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Ground ambulance services have a copay of $295, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, for up to 12 one-way trips per year via rideshare, bus/subway, or medical transport.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by Aetna Medicare Value Plus (HMO-POS). Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $295 copay, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services have no copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Other preventive services such as kidney disease education services have a 20% coinsurance.
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, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids have a maximum plan benefit coverage of $1250.00 per 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
Vision services include eye exams and eyewear. Eye exams have no copay, and eyewear has no copay. Eyewear has a combined maximum plan benefit coverage amount of $325.00 every 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered, while orthodontic services have a $2,000 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B drugs, are covered, but prior authorization is required. 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 by the Aetna Medicare Value Plus (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Aetna Medicare Value Plus (HMO-POS) plan covers Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, and covers Prosthetic Devices with a 20% coinsurance. Medical Supplies have no coinsurance, while 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, including diagnostic procedures/tests and lab services, are covered with no copay for diagnostic procedures/tests and lab services. Therapeutic Radiological Services have a copay of $60, while Diagnostic Radiological Services and Outpatient X-Ray Services have no copay.
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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with a doctor referral, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay information is available below.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $75 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers acupuncture with no copay. Over-the-counter items are covered with no copay up to a maximum of $75 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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