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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 San Diego 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.
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 $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 a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay a $10 copay for preferred generic drugs at a preferred pharmacy. For standard generic drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. It provides no copay for many services, such as primary care, preventive services, and home health. The plan also includes benefits for hearing, vision, and dental services with no copay for exams and certain other services. Additional benefits include coverage for ambulance services, emergency services, and home infusion services. The plan also covers medical equipment, diagnostic services, and skilled nursing facility stays, with specific copayments and coinsurance amounts depending on the service. The plan has no copay for acupuncture, and offers an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by Aetna Medicare Value Plus (HMO-POS). For days 1-5, there is a $100 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay. However, 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 include coverage for outpatient hospital services with a copay between $0 and $100, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $10 copay for both 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 Aetna Medicare Value Plus (HMO-POS), including both ground and air ambulance services. Ground ambulance services have a $245 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 under the Aetna Medicare Value Plus (HMO-POS) plan. 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 no coinsurance, while Worldwide Emergency Transportation has a $245 copay and no coinsurance.
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 services, 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, physical therapy and speech-language pathology services, and other health care professional services have no copay, and occupational therapy services have no copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $10 copay for individual and group sessions, and additional telehealth benefits have a $0-$10 copay and 20% coinsurance. Podiatry services are not covered.
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 wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and a fitness benefit, all with no copay. Kidney disease education services are covered with 20% coinsurance.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a plan-specified maximum benefit of $1250 per year, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, routine eye exams, and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, have no copay and a combined maximum benefit of $325 per year.
Dental Services See details
Dental services include coverage for 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 with no copay. Other dental services have a maximum plan benefit of $2,200 per year. 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, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
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 include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with no copay, and Medical Supplies with no coinsurance. Diabetic Equipment is covered, including Diabetic Supplies with a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, lab services, and all radiological services. Diagnostic Procedures/Tests and Lab Services have no copay, while Therapeutic Radiological Services have a 20% coinsurance, 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 not covered by the Aetna Medicare Value Plus (HMO-POS) plan. While the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO-POS). For days 1-20, there is no copay, and for days 21-100, the copay is $100.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers acupuncture with no copay, and also covers over-the-counter items with no copay, up to $105 every three months. Other services such as meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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