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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.
This summary reflects 2025 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Value Plus (PPO) is a PPO plan offered by CVS Health Corporation available for the 2025 plan year to people living in South Dakota. 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 $48.30. 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 that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5500.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $8950.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of 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 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after your deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at a preferred pharmacy, but will pay 22% coinsurance for standard generic drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a range of benefits with varying cost-sharing. The plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays, and emergency services with copays. Preventive services like annual physical exams have no copay, and the plan also covers hearing and vision services with no copay for routine exams, as well as dental services with a maximum annual benefit. Additional benefits include coverage for ambulance services with a copay or coinsurance, as well as home health services and skilled nursing facility stays with copays. The plan also covers home infusion and dialysis services with a copay or coinsurance, and medical equipment and diagnostic services with copays and coinsurance. Other services like over-the-counter items are covered with no copay, and a maximum benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Value Plus (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $325 copay for days 1-5, and no copay for days 6-90, with additional days covered with no copay. Inpatient Hospital Psychiatric services have a $370 copay for days 1-5, and no copay for days 6-90, with additional days not covered. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered, including 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 $350, while observation services have a $350 copay. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (PPO) plan, with a $245 copay for ground ambulance services and 20% coinsurance for air ambulance services. 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 under the Aetna Medicare Value Plus (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $245 copay for Worldwide Emergency Transportation; there is no coinsurance for any of these services.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, and physician specialist services with a $30 copay. Mental health specialty services and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Opioid treatment program services have a $40 copay, and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value Plus (PPO) plan covers preventive services, including an annual physical exam with no copay, and other preventive services that may have a copay. Kidney Disease Education Services are covered with a 20% coinsurance. The plan also covers Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids have a maximum benefit of $1250 per year.
Vision Services See details
Vision services, including routine eye exams, other eye exam services, and eyewear, are covered. There is no copay for eye exams and eyewear, and routine eye exams are limited to one visit per year, while other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited. Eyewear has a combined maximum plan benefit coverage of $250.00 per year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1,500 per year for both in-network and out-of-network services. Oral exams, dental x-rays, other diagnostic 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
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, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%, and require prior authorization.
Medical Equipment See details
Medical Equipment benefits are covered by the Aetna Medicare Value Plus (PPO) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies have a coinsurance for Medicare-covered devices and supplies. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered under 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. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
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, while days 21-100 have a $214 copay. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay and a maximum benefit of $45 every three months. Other services, including acupuncture, are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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1-877-649-2073 / TTY 711. Call-center hours (ET): Mon-Fri 8am-10pm; Sat 9am-8pm; Sun closed.
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