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.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Aetna Medicare Value Plus (HMO) is a HMO plan offered by Coventry Health Care of Missouri, Inc. available for the 2026 plan year to people living in St. Joe and Surrounding Area. 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 $38.30. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6750.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $6750.00 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 drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when utilizing a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services carry low copays, ranging from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply duration. For brand-name and specialty medications, cost-sharing transitions to coinsurance. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy types. Tier 5 specialty drugs also require a 25% coinsurance, which is limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers affordable coverage for core medical services, featuring no copay and no coinsurance for primary care visits and routine preventive exams. Specialist visits require a copay of up to $40, while inpatient hospital stays require daily copays for the first six days followed by no copay for the remaining days. Outpatient hospital services feature a copay ranging from no copay to $300 with no coinsurance, and emergency care is available with a $130 copay. Supplemental benefits under this plan include preventive dental and routine vision exams with no copay, plus a $175 annual allowance for eyewear. Routine hearing exams also have no copay, and prescription hearing aids are covered up to $1,250 per ear annually. Additionally, members receive home health services with no copay and an over-the-counter product allowance of up to $30 every three months.
Inpatient Hospital See details
Aetna Medicare Value Plus (HMO) covers inpatient hospital services with no coinsurance, requiring a $450 daily copay for days 1 to 6 for acute stays (with no copay for remaining days) and a $390 daily copay for days 1 to 6 for psychiatric stays (with no copay for days 7 to 90). This benefit is partially covered, as 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 $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO) covers partial hospitalization benefits with a copay of either $85.00 or $145.00 and no coinsurance, depending on the service. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Value Plus (HMO), requiring prior authorization and featuring a $260 copay for ground ambulance services alongside a 20% coinsurance for air ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Plus (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, and 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
Aetna Medicare Value Plus (HMO) features primary care physician services with no copay and no coinsurance, while specialist, mental health, podiatry, and therapy visits carry a copay of up to $40 and no coinsurance. Telehealth services are available with a $0 to $40 copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Aetna Medicare Value Plus (HMO) partially covers preventive services, offering annual physical exams, glaucoma screenings, and diabetes self-management with no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, but several supplemental benefits—including weight management, nutritional therapy, and in-home safety assessments—are not covered.
Hearing Services See details
Aetna Medicare Value Plus (HMO) covers Medicare-covered hearing exams for a $40 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 maximum per ear annually, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Aetna Medicare Value Plus (HMO) covers vision services with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This benefit includes one routine eye exam per year and a $175 annual maximum allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), featuring preventive care like exams and cleanings with no copay and no coinsurance, alongside Medicare-covered dental for a $40 copay and no coinsurance. Comprehensive benefits such as restorative and endodontic services are covered up to a $1,500 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copays and prior authorization required. Depending on the item, coinsurance ranges from no coinsurance to 20% coinsurance, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (HMO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $40 copay for procedures, while radiological services feature no copay for x-rays and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Aetna Medicare Value Plus (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (HMO) covers some cardiac rehabilitation services with no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (HMO) covers Skilled Nursing Facility (SNF) services 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 inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit 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 services like meal benefits, annual wellness exams, additional screenings, and over-the-counter items (up to $30 every three months) are covered with no copay and no coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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