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Aetna Medicare Value Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (PPO). 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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in AR - Statewide. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Plus (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 Value Plus (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 Value Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $1.10. 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 $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 $14000.00 (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 $14000.00 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 Value Plus (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay for each drug. For preferred generic drugs, you will pay a $5 copay at preferred pharmacies and $12 at standard pharmacies. For standard generic drugs, the copay is $47. Preferred brand drugs have a $100 copay, and non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a variety of benefits, including inpatient and outpatient hospital care, with varying copays depending on the service. This plan also covers primary care, preventive services, and dental services, with many services having no copay. Additional benefits include coverage for hearing and vision services, ambulance, emergency services, and home health services. There is also coverage for home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $370 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a $678 copay for days 1-3, and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Non-Medicare-covered Stay and Additional Days 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 $370, observation services with a $370 copay, ambulatory surgical center services with no copay, individual and group sessions for outpatient substance abuse with a copay of $40, and outpatient blood services with no copay. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (PPO) plan with prior authorization required, and has a copay of $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Value Plus (PPO) plan. Ground Ambulance Services have a $280 copay, while Air Ambulance Services have a 20% coinsurance. 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 by the Aetna Medicare Value Plus (PPO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Services has a $110 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $280 copay for Worldwide Emergency Transportation. There is no coinsurance for these services.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $25 copay, and physician specialist services with a copay between $0 and $15. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value Plus (PPO) plan covers preventive services with no copay for an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Additional preventive services are covered, though the copay varies. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are also covered with no copay. Prescription hearing aids are covered up to $500 per year, and all types of prescription hearing aids are covered with no copay for 2 visits every year. OTC hearing aids, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $15, and routine eye exams have no copay, with coverage for one exam every year. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $250 every 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; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare Dental Services have a $15 copay. There is a $3,000 annual maximum for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Value Plus (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs are covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Value Plus (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance with prior authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 0-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, and lab services, with a copay ranging from $0 to $95. Diagnostic Radiological Services have a copay of up to $300, 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 (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 not covered by the Aetna Medicare Value Plus (PPO) plan. Medicare-covered intensive cardiac rehabilitation services, Medicare-covered pulmonary rehabilitation services, Medicare-covered supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services, and additional cardiac rehabilitation services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. For days 1-20, there is no copay, 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 (PPO) plan covers Over-the-Counter (OTC) items with no copay, and a maximum benefit coverage amount of $60 every three months. Other services like 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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