A non-government entity
Aetna Medicare Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southwest FL. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (HMO) 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 (HMO).
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 (HMO), 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.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3600.00 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 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Value (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $200 copay for the first five days, with no copay thereafter, while outpatient services may have copays between $0-$185. Emergency services have a $125 copay, and primary care visits are covered with no copay, and specialist visits have a $25 copay. Preventive services, hearing exams, and vision services are covered, with copays ranging from $0-$25. Dental services include a $25 copay for Medicare-covered services, and other benefits like home health services, home infusion, and durable medical equipment are covered with either no copay or varying coinsurance. This plan also covers OTC items up to $75 every three months.
Inpatient Hospital See details
The Aetna Medicare Value (HMO) plan covers Inpatient Hospital services with a $200 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are also covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered with a $200 copay for days 1-5, and no copay for days 6-90, but Additional Days and Non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $185, observation services with a $200 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO) 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, including ground ambulance services with a $250 copay, and air ambulance services with 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered under the Aetna Medicare Value (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $10 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $250 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Value (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, physician specialist services with a $25 copay, and mental health specialty services with a $40 copay. Physical therapy and speech-language pathology services have a $40 copay, while additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Opioid treatment program services also have a $40 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, some with a copay. Kidney disease education services have a 20% coinsurance. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, all with no copay.
Hearing Services See details
Hearing exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a maximum benefit of $1250 per year, and prescription hearing aids (all types) are covered with no copay, while prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (HMO) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with a $0 copay, and a combined maximum of $400 per year. Contact lenses, eyeglasses (lenses and frames), and upgrades are covered with no copay, but eyeglass lenses and frames are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $25 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Restorative Services, Adjunctive General Services, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Endodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Value (HMO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs; other services may have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Aetna Medicare Value (HMO) plan. Durable Medical Equipment has no copay and a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Equipment has a coinsurance, with Diabetic Supplies having a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts having a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay between $0 and $250, lab services with no copay, and outpatient X-ray services with a $50 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and Diagnostic Radiological Services may have a copay of up to $250.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (HMO) 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 under the Aetna Medicare Value (HMO) plan. Although the plan covers Cardiac Rehabilitation Services in general, none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value (HMO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $75 every three months, including nicotine replacement therapy and Naloxone coverage. Other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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