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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:
Sign up for Aetna Medicare Value Care (PPO)
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Drug Coverage
The Aetna Medicare Value Care (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you pay no copay when using a preferred pharmacy or preferred mail-order service for any supply length. If you use standard pharmacies or standard mail-order services, Tier 1 drug copays start at $2.00 and Tier 2 drug copays start at $12.00 for a one-month supply. For higher-tier prescriptions, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options, while Tier 4 non-preferred drugs require 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Care (PPO) plan offers comprehensive coverage for essential medical services, featuring no copay or coinsurance for primary care doctor visits, routine physicals, and annual preventive screenings. Specialist visits require a copay ranging from $10 to $35, while emergency room visits carry a $115 copay which is waived upon admission. For hospital stays, inpatient acute care requires a $407 daily copay for the first six days followed by no copay, and outpatient hospital services carry a copay of up to $495 with no coinsurance. This plan also provides excellent supplemental benefits, including dental care with no copay for preventive services and a 20% to 50% coinsurance for comprehensive care up to a $2,250 annual maximum. Routine vision and hearing exams feature no copay, alongside annual allowances of up to $200 for eyewear and $500 per ear for prescription hearing aids. Furthermore, members receive home health services with no copay, a $45 quarterly over-the-counter item reimbursement, and durable medical equipment covered with a 20% coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Care (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. For acute care, you pay a $407 copay per day for days 1 through 6 and no copay for days 7 and beyond, while psychiatric care requires a $678 copay per day for days 1 through 3 and no copay for days 4 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (PPO) outpatient services are covered with no coinsurance, featuring a copay ranging from $0 to $495 for outpatient hospital services and a $407 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Care (PPO) 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 ground ambulance services with a $295 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
Aetna Medicare Value Care (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are covered with a $115 copay, and worldwide emergency transportation has a $295 copay, all featuring no coinsurance up to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Value Care (PPO) primary care benefits include primary care doctor visits with no copay and no coinsurance, and specialist visits with a $10 to $35 copay and no coinsurance. Therapy, psychiatric, and mental health services have copays ranging from $35 to $50 with no coinsurance, telehealth is offered with a $0 to $40 copay and 20% coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Aetna Medicare Value Care (PPO) covers preventive services with no copay and no coinsurance for annual physicals, screenings, and health education, while kidney disease education has no copay and a 20% coinsurance. This benefit is partially covered, as sub-services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies are not covered.
Hearing Services See details
Hearing services covered by Aetna Medicare Value Care (PPO) include Medicare-covered exams for a $35 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear annually, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Care (PPO) covers vision services with no coinsurance, featuring eye exams for a $0 to $35 copay and routine annual exams with no copay up to a $50 maximum. Covered eyewear, including contact lenses and eyeglasses, has no copay and no coinsurance with a combined annual benefit limit of $200.
Dental Services See details
Aetna Medicare Value Care (PPO) partially covers dental services, offering Medicare-covered dental for a $35 copay and no coinsurance, and preventive services like cleanings, exams, and x-rays with no copay and no coinsurance. Comprehensive services feature no copay and 20% to 50% coinsurance up to a $2,250 annual maximum, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Value Care (PPO) with no copay. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Care (PPO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Care (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no coinsurance to 20% coinsurance, and diabetic therapeutic shoes and inserts are covered with no copay. Prior authorization is required for these benefits, and manufacturer limits apply to diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Care (PPO) with prior authorization required. Diagnostic services feature no coinsurance, no copay for lab services, and copays ranging from $0 to $95 for tests, while radiological services offer outpatient X-rays with no copay, diagnostic radiological services with copays starting at $0, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Value Care (PPO) 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 (PPO) with no coinsurance and a $15 copay. This copay applies to intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Care (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the Aetna Medicare Value Care (PPO) are partially covered, offering no copay and no coinsurance for chronic illness meals, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings, while acupuncture is not covered. Over-the-Counter (OTC) items are also covered with no copay and no coinsurance, providing up to $45 in reimbursement every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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