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Aetna Medicare Value Care (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Care (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 Care (PPO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Care (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Select Counties in GA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Care (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 Care (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 Care (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.40. 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 combined Maximum Out-Of-Pocket cost of $13900.00 (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 $13900.00 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 Care (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options charge a copay starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications require coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs incur a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates apply consistently across all pharmacy and mail-order channels.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan provides comprehensive coverage with many essential services requiring no copay and no coinsurance, including primary care visits, annual routine hearing exams, and home health care. For inpatient hospital stays, members pay a $388 daily copay for the first six days of acute care with no coinsurance. Emergency room visits have a $115 copay, which is waived if you are admitted to the hospital within 24 hours. Specialist visits require a $10 to $20 copay, while dental benefits feature no copay for preventive care and a 20% to 50% coinsurance for comprehensive services up to a $2,000 yearly limit. Major medical needs like dialysis and durable medical equipment are covered with a 20% coinsurance and no copay. Additionally, the plan offers a $50 quarterly over-the-counter allowance and prescription hearing aid coverage up to $500 per ear with no copay.
Inpatient Hospital See details
Inpatient Hospital care is covered by Aetna Medicare Value Care (PPO) with no coinsurance, featuring a $388 copay per day for days 1 to 6 of acute stays and a $678 copay per day for days 1 to 3 of psychiatric stays. There is no copay for subsequent days, but prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $0 to $470 copay for outpatient hospital services. Observation services require a $388 copay per stay, while outpatient substance abuse individual and group sessions have a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Care (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (PPO) covers ambulance services requiring prior authorization, with a $270 copay for ground transport and a 20% coinsurance for air transport. For transportation benefits, some services are covered but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Care (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 limit with copays ranging from $115 to $270 and no coinsurance.
Primary Care See details
Aetna Medicare Value Care (PPO) offers primary care physician visits with no copay and no coinsurance, while specialist visits require a $10 to $20 copay with no coinsurance. Most therapy, psychiatric, and mental health services have copays ranging from $35 to $40 with no coinsurance, though podiatry is not covered and chiropractic benefits are only partially covered since routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services under the Aetna Medicare Value Care (PPO) are partially covered, featuring no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, and select wellness benefits. Kidney disease education is covered with a 20% coinsurance and no copay, though several supplemental services like nutritional therapy, personal emergency response systems, and weight management are not covered.
Hearing Services See details
Aetna Medicare Value Care (PPO) hearing services are partially covered, featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are covered with no copay or coinsurance up to a $500 annual allowance per ear, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Value Care (PPO) with no coinsurance and no deductibles, offering eye exams with a $0 to $20 copay and eyewear with no copay. Patients receive a $50 annual maximum for eye exams, which includes one routine exam per year, and a $200 annual combined maximum for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Value Care (PPO), offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $20 copay and no coinsurance. Covered comprehensive services require no copay and 20% to 50% coinsurance up to a $2,000 yearly limit, while fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Care (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this plan, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Value Care (PPO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers medical equipment, including durable medical equipment, prosthetics, and medical supplies, with no copay and a 20% coinsurance. Diabetic therapeutic shoes and inserts are covered with no copay, while diabetic supplies range from no coinsurance to 20% coinsurance, with prior authorization required for most services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Value Care (PPO) with prior authorization required. Members pay no copay for lab services and outpatient X-rays, a $0 to $95 copay with no coinsurance for diagnostic procedures and tests, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the Aetna Medicare Value Care (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under Aetna Medicare Value Care (PPO) with no coinsurance, though cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Aetna Medicare Value Care (PPO) with no coinsurance, requiring no copay for days 1 to 20 and a $218 copay for days 21 to 100. Prior authorization is required and a 3-day prior hospital stay is not needed, but additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Aetna Medicare Value Care (PPO) partially covers other services, excluding Dual Eligible SNPs with Highly Integrated Services. Covered benefits include acupuncture for a $20 copay and no coinsurance (limited to 12 treatments per year), plus chronic illness meals, wellness exams, mammographies, and a $50 quarterly over-the-counter allowance, all featuring no copay and no coinsurance.
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