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Aetna Medicare Advantra Credit Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Credit Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Advantra Credit Value (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Credit Value (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in West Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Advantra Credit Value (PPO) 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 Advantra Credit Value (PPO).
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 Advantra Credit Value (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $63.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $1600.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 combined Maximum Out-Of-Pocket cost of $11300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $11300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Advantra Credit Value (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, while standard pharmacies have a $12 copay. Standard generic drugs, preferred brand drugs, and non-preferred drugs have 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Advantra Credit Value (PPO) plan offers a wide range of benefits. This plan includes coverage for inpatient and outpatient services, with varying copays depending on the specific service, as well as no copays for services like partial hospitalization, preventive services, vision eyewear, dental cleanings, and home health services. This plan offers coverage for emergency services, primary care, and specialist visits with copays, along with benefits for hearing, vision, and dental care. Other notable benefits include coverage for ambulance services, home infusion, dialysis, medical equipment, and diagnostic services, each with their own cost-sharing arrangements like copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $350 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 include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $375, observation services have a $375 copay, ambulatory surgical center services have no copay, and outpatient substance abuse services (both individual and group sessions) have a copay of $45.00. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Advantra Credit Value (PPO) plan with no copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan. Ground ambulance services have a $325 copay, and air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $325 copay. Worldwide Emergency Services have a maximum plan benefit coverage of $150,000.
Primary Care See details
Primary Care Physician Services have a $5 copay, Chiropractic Services have a $15 copay, and Occupational Therapy Services have a $35 copay. Physician Specialist Services have a copay between $0 and $50, while Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual or group sessions. Podiatry Services and Other Health Care Professional services have varying copays. Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services have a $40 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services are covered with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. Kidney Disease Education Services have a 20% coinsurance. Additional preventive services include: Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), all with no copay. Wigs for Hair Loss Related to Chemotherapy are covered with no copay and a maximum plan benefit coverage amount of $400.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $50 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay; prescription hearing aids have a maximum benefit of $500 per ear, per year. Prescription hearing aids for the 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 a copay between $0 and $50, with routine eye exams and other eye exam services having no copay. Eyewear has no copay, with a combined maximum plan benefit coverage of $185 per year for both in-network and out-of-network services.
Dental Services See details
The Aetna Medicare Advantra Credit Value (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services, including oral exams, dental x-rays, and cleanings, with no copay. This plan's dental services have a maximum benefit of $1000 per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization 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 under the Aetna Medicare Advantra Credit Value (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a coinsurance between 0% and 20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Medical Supplies have a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $25, and lab services with no copay. Diagnostic radiological services have a copay of at most $325, while therapeutic radiological services have a coinsurance of at least 20%, and outpatient X-ray services have a copay of $50.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Credit Value (PPO) 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 by the Aetna Medicare Advantra Credit Value (PPO) plan, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for Cardiac Rehabilitation Services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Credit Value (PPO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, and Self-Directed Personal Assistance Services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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