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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 2026, 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 2026.
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 $20.80. 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 Plus (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order services charge copays ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 drugs. For higher-tier medications, the plan utilizes coinsurance rather than set copayments. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order fills. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, routine preventive services, and home health care. For hospital services, members pay a daily copay for the first few days of inpatient stays with no coinsurance, while outpatient procedures range from no copay to a $450 copay. Emergency care is accessible with a $115 copay, which is waived if admitted, and includes worldwide emergency coverage. This plan also provides robust supplemental benefits, including routine dental, vision, and hearing exams with no copay. Members receive allowances of up to $200 annually for eyewear and $500 per ear for prescription hearing aids, plus comprehensive dental care up to a $1,500 annual limit with no copay and 20% to 50% coinsurance. Additionally, the plan features a $45 quarterly over-the-counter reimbursement and fitness benefits with no copay.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient hospital services with no coinsurance, requiring a $407 daily copay for days 1 to 6 of acute stays and a $678 daily copay for days 1 to 3 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and specific services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $450, while patients pay a $407 copay per stay for observation services and a $40 copay per session for outpatient substance abuse services.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance services under Aetna Medicare Value Plus (PPO) are covered with prior authorization, requiring a $295 copay and coinsurance for ground transport, and a copay plus 20% coinsurance for air transport, while health-related transportation services are not covered.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent services are also covered up to a $250,000 maximum benefit with no coinsurance, carrying a $115 copay for emergency or urgent care and a $295 copay for emergency transportation.
Primary Care See details
Aetna Medicare Value Plus (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Outpatient therapies and mental health services require copays up to $40 with no coinsurance, while podiatry is not covered and chiropractic benefits have some services covered but exclude routine and other chiropractic care.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (PPO), with most services—including annual physicals, screenings, and fitness benefits—offered with no copay and no coinsurance, though kidney education requires a 20% coinsurance and no copay. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Hearing services under the Aetna Medicare Value Plus (PPO) are partially covered, featuring Medicare-covered exams for a $40 copay and routine exams or fitting evaluations with no copay, all with no deductible and no coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to a $500 maximum per ear annually, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services with no deductibles or coinsurance, offering routine eye exams with no copay and Medicare-covered exams with a $0 to $40 copay. Eyewear is also covered with no copay or coinsurance, providing a $200 annual combined maximum benefit for contacts, frames, and lenses.
Dental Services See details
Aetna Medicare Value Plus (PPO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive services are covered with no copay and 20% to 50% coinsurance up to a $1,500 annual maximum, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Value Plus (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies and therapeutic shoes or inserts are also covered, requiring a $10 copay for shoes or inserts and coinsurance ranging from no coinsurance to 20% for supplies, with prior authorization required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO), though prior authorization is required. Lab services and diagnostic tests require no coinsurance, with copays ranging from no copay for labs up to $95 for tests, while radiological services require a minimum 20% coinsurance for therapeutic services and no copay for X-rays.
Home Health Services See details
Home health services are covered by the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, but only some services are covered as standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered. Copayments for these specific services range from $20 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Value Plus (PPO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) provides partially covered Other Services, which exclude acupuncture. Covered benefits include chronic illness meals, annual wellness exams, additional colorectal screenings, and a $45 quarterly over-the-counter reimbursement, all of which feature no copay and no coinsurance.
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