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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 St. Joe and Surrounding 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 $45.10. 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 $6350.00 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 will 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 or through the mail, while you will pay a 24% coinsurance for standard generic drugs. 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 wide range of benefits with varying cost-sharing structures. You'll find no copays for primary care, preventive services, eye exams, eyewear, and many dental services. Additionally, the plan provides coverage for inpatient hospital stays, outpatient services, hearing services, and more, with specific copays and coinsurance amounts depending on the service. This plan includes coverage for emergency services, ambulance services, and home health services, with varying copays and coinsurance. It also offers benefits like over-the-counter items, a meal benefit, and additional services like acupuncture. However, it's important to note that certain services such as cardiac rehabilitation and additional hours of home health care are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Aetna Medicare Value Plus (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-4 and no copay for days 5-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-5 and no copay for days 6-90; additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO) plan, with a $85 copay. Prior authorization is required for this benefit.
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. 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 under the Aetna Medicare Value Plus (HMO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a $25 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $260 copay; all services have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $30 copay. Physician Specialist Services have a copay between $0 and $25, and Mental Health Specialty Services, Opioid Treatment Program Services, and Psychiatric Services all have a $25 copay for both individual and group sessions. Podiatry Services and Other Health Care Professional services have a $25 and a $0-$25 copay, respectively. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $25.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services. Additional preventive services include Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services has a 20% coinsurance.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are covered up to a maximum of $1500 per year, but the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear. OTC Hearing Aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (HMO) plan covers vision services including eye exams and eyewear. Eye exams and eyewear have no copay. The plan offers a combined maximum of $295.00 per year for eyewear.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services and a $1,500 annual maximum benefit. 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 are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. 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, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Value Plus (HMO) plan, including Durable Medical Equipment (DME) with no copay and 0% to 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $30, and lab services with no copay. Diagnostic Radiological Services have a copay up to $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 under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance; however, 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. Services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value Plus (HMO) plan, with a prior authorization requirement. You will pay a copay of $10 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO) plan covers acupuncture with a $20 copay, and over-the-counter items with no copay. The plan also offers a meal benefit with no copay, and covers annual wellness exams, screening mammography, gFOBT, and FIT with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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