A non-government entity
Aetna Medicare Value Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (HMO). 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 (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Limited counties Missouri and Kansas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Plus (HMO) 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 (HMO).
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 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.40. 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 Maximum Out-Of-Pocket cost of $4900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require copays ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. Higher-tier medications require coinsurance instead of flat copays. You will pay a 22% coinsurance for Tier 3 preferred brand drugs across all pharmacies and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance, with Tier 5 coverage limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers robust medical coverage with low out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. Specialist visits range from no copay to a twenty-five dollar copay, while inpatient hospital stays require a daily copay for the first six days with no coinsurance. Emergency care is accessible with a one-hundred-thirty-dollar copay, which is waived if you are admitted, and urgent care carries a twenty-five-dollar copay. This plan also includes strong supplemental benefits, highlighted by comprehensive vision care with no copays, no coinsurance, and a two-hundred-fifty-dollar annual allowance for eyewear. Preventive dental services and routine hearing exams feature no copay, with additional coverage of up to three-thousand dollars for comprehensive dental services and up to one-thousand-two-hundred-fifty dollars per ear for prescription hearing aids. Members also benefit from an over-the-counter allowance of seventy-five dollars every three months with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Aetna Medicare Value Plus (HMO) with no coinsurance, requiring a $325 daily copay for days 1 through 6 of acute stays (no copay for days 7 and beyond) and a $275 daily copay for days 1 through 6 of psychiatric stays (no copay for days 7 through 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, featuring a $0 to $300 copay for outpatient hospital services and a $325 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 services require a $25 copay per session with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO) covers partial hospitalization services with a copay of $85.00 or $145.00 and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (HMO) covers ambulance services with prior authorization, requiring a $260 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Plus (HMO) with a $130 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 maximum with no coinsurance and copays ranging from $130 to $260.
Primary Care See details
Primary care benefits under Aetna Medicare Value Plus (HMO) feature no copay and no coinsurance for primary care visits, while specialist services range from a $0 to $25 copay with no coinsurance. Most other services like physical therapy, mental health, and podiatry require a $25 copay and no coinsurance, telehealth has a $0 to $25 copay and 20% coinsurance, and chiropractic care is not covered.
Preventive Services See details
Aetna Medicare Value Plus (HMO) partially covers preventive services, offering no copay and no coinsurance for annual physicals, health education, and fitness benefits, while kidney disease education requires a 20% coinsurance. Several supplemental options are not covered, including personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Aetna Medicare Value Plus (HMO) partially covers hearing services, featuring Medicare-covered exams for a $25 copay and no coinsurance, plus annual routine exams and fitting evaluations with no copay and no coinsurance. While prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Aetna Medicare Value Plus (HMO) provides comprehensive vision coverage with no copays, no coinsurance, and no deductibles for all covered services. Members receive one routine eye exam per year and a $250 annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), with Medicare-covered services requiring a $25 copay and no coinsurance, while covered preventive care has no copay and no coinsurance. Comprehensive services are covered up to a $3,000 annual maximum with no copay and 20% to 50% coinsurance; however, fluoride treatments, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (HMO) covers home infusion bundled services with no copay and no coinsurance, although prior authorization and step therapy are required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs are covered with no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and prior authorization required. Beneficiaries will pay a 20% coinsurance for prosthetic devices and diabetic shoes, and between no coinsurance and 20% coinsurance for DME, medical supplies, and diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (HMO), requiring prior authorization for all services. Lab services, outpatient X-rays, and diagnostic radiological services have no copay or coinsurance, while diagnostic tests carry a $0 to $25 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Value Plus (HMO) with no coinsurance, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, requiring a $10 daily 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, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year. Other covered services, including over-the-counter items up to $75 every three months, chronic illness meal benefits, and annual wellness screenings, are available with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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