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Aetna Medicare Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (HMO-POS). 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-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Eastern Missouri. 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-POS) 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-POS).
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-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $30.90. 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 $4200.00 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-POS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order services charge copays starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. For higher-tier medications, this plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive screenings, and home health services. For hospital care, inpatient stays require daily copays of $310 to $335 for the first six days with no coinsurance, while emergency room visits carry a $150 copay. Specialist visits and urgent care are also highly accessible, requiring a copay of up to $25 with no coinsurance. This plan also features robust supplemental benefits, including no copay or coinsurance for routine dental cleanings, annual eye exams, and routine hearing evaluations. Members receive valuable allowances, including a $300 annual limit for eyewear, up to $1,250 per ear annually for prescription hearing aids, and a $120 quarterly allowance for over-the-counter items. Additionally, comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $2,000 yearly limit.
Inpatient Hospital See details
Aetna Medicare Value Plus (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care features a $335 daily copay for days 1–6 and no copay for unlimited additional days, while psychiatric care requires a $310 daily copay for days 1–6 and no copay for days 7–90. 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-POS) with no coinsurance, featuring copays ranging from $0 to $275 for hospital services and a $335 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions carry a $25 copay with no coinsurance.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO-POS) covers partial hospitalization services with no coinsurance, requiring a copay of either $85.00 or $180.00 depending on the service. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (HMO-POS) covers ambulance services with prior authorization, requiring a $290.00 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Aetna Medicare Value Plus (HMO-POS) covers emergency services with a $150 copay—waived if admitted to the hospital within 24 hours—and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance and copays ranging from $150 to $290.
Primary Care See details
Aetna Medicare Value Plus (HMO-POS) covers primary care visits with no copay and no coinsurance, while specialists, therapy, and mental health services require up to a $25 copay (with no copay for some services) and no coinsurance. Chiropractic services are not covered, and telehealth benefits are offered with no copay to a $25 copay and 20% coinsurance.
Preventive Services See details
Preventive services are covered by Aetna Medicare Value Plus (HMO-POS) with no copay and no coinsurance for annual physical exams, health education, and screenings, while kidney disease education has a 20% coinsurance and no copay. The benefit is partially covered, as supplemental services like weight management, personal emergency response systems, counseling, and nutritional benefits are not covered. Covered wigs for chemotherapy-related hair loss have a $400 annual limit with no copay and no coinsurance.
Hearing Services See details
Aetna Medicare Value Plus (HMO-POS) partially covers hearing services, offering annual routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear every year with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (HMO-POS) with no copay and no coinsurance, including one routine eye exam annually and unlimited follow-up diabetic eye exams. Covered eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, also has no copay or coinsurance up to a combined maximum benefit of $300 every year.
Dental Services See details
Aetna Medicare Value Plus (HMO-POS) offers partially covered dental services, featuring no copay and no coinsurance for preventive care like exams and cleanings, and a $25 copay with no coinsurance for Medicare-covered dental. Comprehensive services have no copay and 20% to 50% coinsurance up to a $2,000 yearly limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (HMO-POS) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while other Part B chemotherapy and drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Value Plus (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (HMO-POS), with durable medical equipment (DME) and medical supplies requiring no copay and ranging from no coinsurance to 20% coinsurance. Prosthetic devices feature a 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Aetna Medicare Value Plus (HMO-POS) plan, with prior authorization required. Lab services, outpatient X-rays, and diagnostic radiological services feature no copay, diagnostic procedures have a $0 to $25 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Value Plus (HMO-POS) with no coinsurance, but some services are covered while standard 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-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 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 required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Value Plus (HMO-POS) with no copay and no coinsurance for wellness exams, chronic illness meals, and up to $120 every three months in over-the-counter (OTC) items. Acupuncture is not covered under this plan.
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