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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 Select Counties in GA. 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 $40.00. 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 $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 an enhanced alternative drug benefit. The plan has a $590 deductible. In the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have 24% coinsurance at both preferred and standard pharmacies. 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 wide range of benefits with varying costs. This plan includes inpatient hospital stays with a copay, outpatient services with copays, and emergency services with copays. You'll also find coverage for primary care with no copay, preventive services with no copay, and dental services with a $2,000 annual maximum. Additional benefits include hearing and vision services, ambulance services, and home health services with no copay. The plan also covers diagnostic and radiological services, skilled nursing facility services, and other services like acupuncture and over-the-counter items. However, some services like cardiac rehabilitation and additional hours of care are not covered.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers inpatient hospital stays, including services not usually covered by Medicare, with a copay of $373 for days 1-6 and no copay for days 7-90. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $678 for days 1-3 and no copay for days 4-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $373, Observation Services with a $373 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. You will pay an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $270 copay, while air ambulance services have 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 have a $110 copay, and Urgently Needed Services have a $40 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $270 copay.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, and specialist services with a copay between $0 and $10. Chiropractic Services have a $10 copay, while Occupational Therapy Services have a $25 copay. Mental Health and Psychiatric individual and group sessions have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40. Other Health Care Professional services have a copay between $0 and $10. Opioid Treatment Program Services have a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam and other preventive services with no copay. Kidney Disease Education Services are covered with 20% coinsurance.
Hearing Services See details
Hearing services with Aetna Medicare Value Plus (PPO) include hearing exams with a $10 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $500 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services, including eye exams with a copay between $0 and $10, and eyewear with no copay, up to a combined maximum of $360 per year for both in-network and out-of-network services. Routine eye exams are limited to one per year with no copay, and other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are unlimited with no copay.
Dental Services See details
The Aetna Medicare Value Plus (PPO) plan covers dental services, with a $2,000 annual maximum benefit. Diagnostic and preventive services like oral exams, dental x-rays, and cleanings have no copay, while Medicare dental services have a $10 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Aetna Medicare Value Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by 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 benefits are covered by Aetna Medicare Value Plus (PPO), including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a coinsurance of 0-20%, and Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $95, and lab services with no copay. Outpatient X-ray services have no copay, while diagnostic radiological services have a copay up to $300, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, but 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. While Cardiac Rehabilitation Services are generally covered, the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (PPO) plan, requiring prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond what Medicare covers, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan covers acupuncture with a $20 copay for up to 12 treatments per year, and over-the-counter items with no copay, up to $75 every three months. Additionally, this plan offers a meal benefit with no copay, and covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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