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Aetna Medicare Value Care (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Care (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 Care (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Value Care (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Care (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 Care (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 Care (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $41.00. 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 a $615.00 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 $3900.00 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 Care (HMO-POS) plan has an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail order service. If you use standard pharmacies or standard mail order, Tier 1 copays start at $2.00 and Tier 2 copays start at $12.00 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance regardless of the pharmacy type you choose. You will pay 22% coinsurance for Tier 3 preferred brand drugs, and 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Care (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay or coinsurance for primary care visits, preventive screenings, and home health services. For specialized care, members pay a low $20 copay for specialist visits and physical therapy, while inpatient hospital stays require a $350 daily copay for the first five days and no copay for days six and beyond. Emergency room visits carry a $150 copay, which is waived if admitted, and urgent care is available for a $50 copay. This plan also includes valuable supplemental benefits, such as routine vision and hearing exams with no copay, alongside allowances of up to $200 annually for eyewear and $1,250 per ear for prescription hearing aids. Dental care is covered with no copay for most services up to a $1,100 yearly limit, and a $20 copay for Medicare-covered dental treatments. Additionally, members benefit from no copays on durable medical equipment, diagnostic lab tests, and a quarterly $30 over-the-counter item allowance.
Inpatient Hospital See details
Aetna Medicare Value Care (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for days 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, featuring a $370 daily copay for days 1 to 5 and no copay for days 6 to 90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Value Care (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with copays ranging from $0 to $350 and outpatient substance abuse sessions with a $40 copay. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most outpatient care.
Partial Hospitalization See details
Aetna Medicare Value Care (HMO-POS) covers partial hospitalization services with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (HMO-POS) covers ground ambulance services with a $350 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Care (HMO-POS) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $150 to $350.
Primary Care See details
Aetna Medicare Value Care (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $20 copay and no coinsurance. Mental health, psychiatric, and opioid treatments have a $40 copay and no coinsurance, other health professionals require a $0 to $20 copay and no coinsurance, and telehealth has a $0 to $50 copay and 20% coinsurance. Podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Care (HMO-POS), featuring no copay and no coinsurance for annual physical exams, health education, and various screenings, while kidney disease education has no copay but a 20% coinsurance. Uncovered services include weight management, nutritional/dietary benefits, alternative therapies, personal emergency response systems, and in-home support.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Care (HMO-POS), featuring no copays and no coinsurance for routine hearing exams, fittings, and prescription hearing aids up to a $1,250 maximum per ear each year. However, over-the-counter (OTC) hearing aids, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Aetna Medicare Value Care (HMO-POS) covers vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam and follow-up diabetic eye exams per year. Eyewear, including contact lenses and eyeglasses, is also covered with no copay or coinsurance up to a $200 annual combined maximum.
Dental Services See details
Dental services are partially covered under Aetna Medicare Value Care (HMO-POS), featuring a $20 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other covered dental services up to a $1,100 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Care (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Care (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Aetna Medicare Value Care (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Value Care (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have no coinsurance and a $0 to $20 copay, lab and diagnostic radiological services have no copay, outpatient X-rays require a $10 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Value Care (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Value Care (HMO-POS) with no coinsurance, though some services are not covered. Specifically, standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and a 3-day inpatient hospital stay is not required before admission, though additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Value Care (HMO-POS) plan, which features no copay and no coinsurance for a chronic illness meal benefit, annual wellness exams, screening mammographies, and select cancer screenings. Additionally, over-the-counter (OTC) items are covered with no copay and no coinsurance up to $30 every three months, although acupuncture is not covered.
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