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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 2026, 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 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 $28.20. 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 $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 features an annual prescription 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 options charge a copay ranging from $2 to $12 for a one-month supply of these generic drugs. For higher-tier medications, the plan utilizes percentage-based 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 tier prescriptions limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care physician visits, routine vision exams, and most preventive services. For inpatient hospital stays, members pay a $300 copay per day for the first four to five days and no copay for subsequent days, with no coinsurance required. Emergency room visits carry a $130 copay, which is waived if admitted, while urgently needed services require a $20 copay. This plan also provides valuable supplemental benefits, including a $300 annual eyewear allowance and a $1,250 annual hearing aid limit per ear with no copay or coinsurance. Preventive dental care is covered with no copay, and comprehensive dental services require no copay with a 20% to 50% coinsurance up to a $2,500 yearly limit. Additionally, members receive a $75 over-the-counter item allowance every three months and home health services with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, requiring a $300 copay for days 1 to 4 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered, as unlimited additional acute days are covered, but additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $275 copay and observation services with a $300 copay per stay. Additionally, there is no copay for ambulatory surgical center or blood services, while outpatient substance abuse individual and group sessions carry a $20 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (HMO), though some transportation services are not covered, specifically trips to plan-approved or any other health-related locations. Covered ground ambulance services require a $260 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance transports.
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, and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency services are also covered up to a $250,000 limit with no coinsurance, requiring a $130 copay for emergency and urgent care, and a $260 copay for emergency transportation.
Primary Care See details
Primary care benefits under the Aetna Medicare Value Plus (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist, therapy, podiatry, and mental health services require a $0 to $20 copay and no coinsurance. Telehealth options are available with a $0 to $20 copay and 20% coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (HMO), with most options—including annual physicals, fitness benefits, and glaucoma screenings—offering no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, while several sub-services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered under the Aetna Medicare Value Plus (HMO) plan, featuring a $20 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,250 limit per ear annually, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (HMO) with no copay and no coinsurance for exams and eyewear. Members receive one routine eye exam per year and a $300 annual maximum allowance for eyewear, including contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), with Medicare-covered dental requiring a $20 copay and no coinsurance, and preventive cleanings and exams available with no copay and no coinsurance. Comprehensive benefits are covered with no copay and 20% to 50% coinsurance up to a $2,500 annual limit, though other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these benefits, 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 for these services. Diagnostic tests and procedures feature no coinsurance and a copay ranging from $0 to $20, while lab services and outpatient X-rays are available with no copay. Diagnostic radiological services start at no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by Aetna Medicare Value Plus (HMO) with no copay and no coinsurance, but only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 needed for admission, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO) covers acupuncture with a $20 copay and no coinsurance, up to a limit of 12 treatments per year. Other benefits including chronic illness meals, annual wellness exams, screening mammographies, select colorectal screenings, and up to $75 in over-the-counter items every three months are covered with no copay and no coinsurance.
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