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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 Topeka and Surrounding Areas. 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 $44.70. 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. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, while standard pharmacies have a $12 copay. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 24% or 25% coinsurance depending on the tier. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services can have copays up to $325. Emergency services, primary care visits, and many specialist visits have copays, while preventive services like annual physical exams and some vision and dental services have no copay. The plan also includes coverage for hearing aids, vision and dental services, and medical equipment with varying copays and coinsurance. Additional benefits include home health services with no copay, and coverage for acupuncture, over-the-counter items, and a meal benefit. However, some services like cardiac rehabilitation, additional hospital days, and certain types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-4, and no copay for days 5-90; additional days and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-5, and no copay for days 6-90; additional days and non-Medicare covered stays are 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 of $0-$325, Observation Services have a $250 copay, Ambulatory Surgical Center Services have no copay, and both Individual and Group Sessions for Outpatient Substance Abuse have a $30 copay. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO) plan, but requires prior authorization. The copay for this benefit is $85.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (HMO) plan. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value Plus (HMO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $260 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Aetna Medicare Value Plus (HMO) plan. Primary Care Physician Services and Physician Specialist Services have a copay of $0 to $30. Chiropractic Services have a $20 copay. Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Medicare-covered Podiatry Services, Routine Foot Care, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay. Additional Telehealth Benefits have a $0 to $30 copay and a 20% coinsurance. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, such as Glaucoma Screening, have no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum benefit of $1500 per year, and prescription hearing aids (all types) have no copay. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Aetna Medicare Value Plus (HMO) plan covers vision services, including eye exams with no copay, and routine eye exams with no copay for one visit per year. Eyewear benefits are covered with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $230 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, 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. Orthodontic services are covered under Diagnostic and Preventive Dental, and the plan has a $2,500 maximum benefit each year, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The plan has a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (HMO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is also covered, with coinsurance between 0% and 20% for Diabetic Supplies and 20% for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-Ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $30, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $140, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for acupuncture with a $20 copay, over-the-counter items with no copay, and a meal benefit with no copay. The plan also covers annual wellness exams, screening mammography, and gFOBT/FIT with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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