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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 2025, 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 Kansas City Metro Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 $47.00. 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 Maximum Out-Of-Pocket cost of $5500.00 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 has a $590 deductible for prescription drugs. Once you meet your deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy, and 24% coinsurance for standard generic drugs at any pharmacy. In the initial coverage phase, you will pay these costs until your total drug costs reach $2,000. After that, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency and urgent care services have copays, and primary care visits have no copay. Preventive services, including an annual physical, have no copay, and the plan also covers hearing, vision, and dental services with no copay in many instances. The plan offers additional benefits such as home health services, and over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Aetna Medicare Value Plus (HMO) plan. For Inpatient Hospital-Acute, there is a $250 copay for days 1-4, and no copay for days 5-90, and for Inpatient Hospital Psychiatric, there is a $250 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered under the Aetna Medicare Value Plus (HMO) plan. Outpatient hospital services have a copay between $0 and $250, while observation services have a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $15.
Partial Hospitalization See details
Partial Hospitalization is covered with a $85 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (HMO). Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $15 copay, and Worldwide Emergency Transportation has a $260 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and specialist visits with a $0-$15 copay. Mental health and psychiatric services have a $15 copay for individual and group sessions, and podiatry services have a $15 copay for routine foot care. Other health care professional visits have copays between $0 and $15, physical therapy and speech-language pathology services have a $20 copay, and opioid treatment program services have a $15 copay. Additional telehealth benefits are covered with a 20% coinsurance and a $0-$15 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services like health education, wigs for hair loss, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, remote access technologies, and fitness benefits, which are covered with no copay. Kidney disease education services have a 20% coinsurance.
Hearing Services See details
Hearing Services include coverage for Hearing Exams with a $15 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids (all types) are covered with no copay, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services under the Aetna Medicare Value Plus (HMO) plan include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $245.00 per year.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $15 copay, and other dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, while maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit of $2,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by the Aetna Medicare Value Plus (HMO) plan, but require prior authorization. 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 under the Aetna Medicare Value Plus (HMO) plan. The plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance of 0% to 20%, and Diabetic Supplies have a coinsurance of 0% to 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Value Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $140, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (HMO) 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 (HMO) plan. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO) plan covers acupuncture with a $15 copay, and also covers over-the-counter items with no copay up to a $75 limit every three months. The plan also covers a meal benefit with no copay. Other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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