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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 Cobb and Paulding. 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 $9.00. 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 a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and where you get your prescriptions filled. For preferred generic drugs, you will have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For other tiers, you will pay coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. The plan also covers primary care services with no copay for many services, as well as preventive, hearing, vision, and dental services, with copays or coinsurance applying to some services. Additional benefits include ambulance services, emergency services, home health services, and durable medical equipment. The plan also provides coverage for home infusion, dialysis, and skilled nursing facilities. However, it's important to note that some services, such as cardiac rehabilitation and certain dental procedures, may not be covered or have limitations.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $373 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll pay a $678 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for 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 $373, observation services have a $373 copay, ambulatory surgical center services have no copay, and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (PPO). Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations 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; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $260 copay; all three have no coinsurance.
Primary Care See details
Primary care includes coverage for primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $10-$20 copay, and physical therapy and speech-language pathology services with a $25 copay. Mental health specialty services and psychiatric services have a $40 copay for both individual and group sessions, and other health care professional services have a $0-$20 copay. Additional telehealth benefits have a 20% coinsurance and a $0-$40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services, such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, also with no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Value Plus (PPO) plan, including hearing exams with a $20 copay. Prescription hearing aids are covered up to $500 per ear every year, with two visits per year with no copay for prescription hearing aids (all types).
Vision Services See details
The Aetna Medicare Value Plus (PPO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay and a combined maximum of $250 per year for both in-network and out-of-network services. Routine eye exams are covered once per year with no copay, and other eye exam services are covered with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other dental services with a maximum plan benefit of $2250 per year. Some preventive services, like oral exams, dental x-rays, and cleanings have no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value Plus (PPO) plan, including Medicare Part B insulin drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Equipment is also covered, with Diabetic Therapeutic Shoes/Inserts having no copay and Diabetic Supplies with 0-20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and 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, with no copay for days 1-20 and a $214 copay per day for days 21-100. Additional days beyond Medicare coverage 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 $10 copay, and covers over-the-counter items with no copay, up to a $90 maximum benefit every three months. Meal benefits and other services like annual wellness exams and screenings also have no copay. However, the plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services.
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