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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 SW MO / SE KS 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 $45.90. 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 $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 an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay the following costs for your drugs. For preferred generic drugs, there is no copay at preferred pharmacies or preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance depending on the tier and pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copays for many services such as primary care visits, preventive care, eye exams, and dental cleanings. You'll also find coverage for hospital stays, outpatient services, and emergency care with various copays depending on the service. Additional benefits include coverage for hearing and vision services, with copays for hearing exams and prescription hearing aids, and no copays for vision exams and eyewear. The plan also includes coverage for ambulance, home health, and skilled nursing facility services, with some services requiring copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $250 copay for days 1-4, and no copay for days 5-90; for Inpatient Hospital Psychiatric, you'll pay a $250 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $275, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services are covered with no copay, and Outpatient Substance Abuse Services are covered with a $20 copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO) plan, but requires prior authorization. You will have a copay of $85 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, and air ambulance services have a 20% coinsurance, while transportation services to health-related locations 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 have a $125 copay with no coinsurance, Urgently Needed Services have a $20 copay with no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $260 copay; all of these services 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 $20 copay, and occupational therapy services with a $15 copay. The plan also covers physician specialist services with a copay between $0 and $20, mental health specialty services, and podiatry services with a $20 copay. Other covered services include other health care professional services with a copay between $0 and $20, psychiatric services, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $20, and opioid treatment program services with a $20 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services are covered. Other services covered with no copay include Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Fitness Benefit. Kidney Disease Education Services has a 20% coinsurance.
Hearing Services See details
Hearing exams are covered with a $20 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a maximum plan benefit coverage of $1500 per year, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams and other eye exam services. Eyewear also has no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $285 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services with a $2,500 annual maximum. 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 have no copay. 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 with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) plan, but require prior authorization. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Value Plus (HMO), 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 covered with coinsurance for Medicare-covered supplies and therapeutic shoes or inserts, as well as Diabetic Supplies with 0% to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay for all diagnostic procedures/tests ranging from $0 to $20, and lab services with no copay. Radiological services are covered, with a copay of up to $140 for diagnostic radiological services, and a coinsurance of at least 20% for therapeutic radiological services; 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. While the plan covers cardiac rehabilitation services, the specific sub-services are not covered.
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 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO) plan covers acupuncture with a $20 copay, and also covers over-the-counter items with no copay, up to a maximum of $75 every three months. The plan's other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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