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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 Fresno County. 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.

Overview IconKey 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 $11.00. 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 $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 $2900.00 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $140.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for Aetna Medicare Value Plus (HMO-POS)

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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 IconDrug Coverage

The Aetna Medicare Value Plus (HMO-POS) plan has a $250 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance based on the drug tier and the pharmacy you use. For example, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy. The plan also has an initial coverage phase where you pay for your drugs until your total drug costs reach $2000. Once you reach this amount, you enter the catastrophic coverage phase where you pay nothing for your drugs.

Additional Benefits IconAdditional Benefits

The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan features no copays for many services, including primary care visits, outpatient substance abuse services, preventive services, hearing and vision exams, dental services, and home health services. You'll pay a copay for inpatient hospital stays, emergency services, ambulance, outpatient services, and some prescription drugs.

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. For Inpatient Hospital-Acute, you will pay a $425 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $360 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $175, while observation services, ASC services, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $10.

Partial Hospitalization See details

Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan with prior authorization required, and there is no copay.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (HMO-POS). Ground ambulance services have a $150 copay, and air ambulance services have a 20% coinsurance, while 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 and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay, and Worldwide Emergency Transportation has a $150 copay, while Urgently Needed Services has no copay.

Primary Care See details

The Aetna Medicare Value Plus (HMO-POS) plan offers Primary Care benefits, including no copay for Primary Care Physician Services, Chiropractic Services, and Routine Chiropractic Care. Occupational Therapy Services, Physician Specialist Services, and Other Health Care Professional services have no copay. Mental Health Specialty and Psychiatric Services have a $10 copay for individual and group sessions. Additional Telehealth Benefits have a 20% coinsurance with a copay between $0 and $10. Opioid Treatment Program Services have a $10 copay.

Preventive Services See details

Preventive services include annual physical exams with no copay, and other preventive services with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. This plan also covers Kidney Disease Education Services with 20% coinsurance. Additional services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.

Hearing Services See details

Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $1250 per year, with no copay. 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 include eye exams and eyewear. Eye exams have no copay, and include routine eye exams, other eye exam services. Eyewear has no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $325 per 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. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.

Dialysis Services See details

Dialysis Services are covered by 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 no copay and a 0-20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with no coinsurance. Diabetic Equipment is also covered, with coinsurance and copay information available in the plan details.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests and Lab Services have no copay, while Diagnostic Radiological Services have a copay of up to $50, and Therapeutic Radiological Services have a coinsurance of at least 20%. 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. However, 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 service.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The Aetna Medicare Value Plus (HMO-POS) plan covers acupuncture with no copay, and also covers over-the-counter (OTC) items with no copay up to $75 every three months. This plan does not cover meal benefits and some other services.

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