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Aetna Medicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (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 (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Triangle North Carolina Area. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (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 (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 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4900.00 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 (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay a $5 copay at a preferred pharmacy for preferred generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan provides comprehensive coverage for various healthcare needs. It includes no copay for primary care, preventive services, vision, and dental services, as well as many other services. The plan also covers inpatient hospital stays, outpatient services, and emergency services, with varying copays for different services. This plan offers additional benefits like hearing exams, prescription hearing aids with no copay, and a maximum benefit for eyewear. It also covers home health services, medical equipment, and diagnostic and radiological services. However, it's important to note that some services, such as cardiac rehabilitation, and certain types of hearing aids, are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a copay of $374 for days 1-8, and no copay for days 9-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a copay of $286 for days 1-8, and no copay for days 9-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered under the Aetna Medicare Value (HMO-POS) plan. Outpatient Hospital Services have a copay between $0 and $374, while Observation Services have a copay of $374. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay of $40 for both Individual and Group Sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan. Ground ambulance services have a $275 copay, while air ambulance services have 20% coinsurance; however, 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 by the Aetna Medicare Value (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $275 copay, all with no coinsurance.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $20 copay, and mental health specialty services with a $40 copay. The plan also covers other health care professional services with a copay between $0 and $20, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with 20% coinsurance and a copay between $0 and $45, and opioid treatment program services with a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline) with no copay, and wigs for hair loss related to chemotherapy with no copay and a maximum plan benefit coverage amount of $400 per year. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, including Medicare-covered Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay; prescription hearing aids are covered with a plan-specified amount per period, and OTC hearing aids are not covered. Prescription hearing aids (all types) are covered with no copay. However, prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Aetna Medicare Value (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with no copay. Routine eye exams are covered with no copay once per year, and other eye exam services, including follow up diabetic eye exams, are covered with no copay. Eyewear benefits include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay, with a combined maximum benefit of $100 per year.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $20 copay, and other dental services are covered with an annual maximum benefit of $1600. 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 under the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. 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 (HMO-POS) plan, but require prior authorization. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment (DME) with no copay and a 0-20% coinsurance. Prosthetics/medical supplies are covered with no copay and a coinsurance for Medicare-covered items, while diabetic equipment is covered, with coinsurance for Medicare-covered therapeutic shoes/inserts and copays for diabetes supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay ranging from $0 to $100, lab services with no copay, and outpatient X-ray services with a $14 copay. Therapeutic Radiological Services have a coinsurance of at least 20%, and there is a maximum copay of $300 for Diagnostic Radiological Services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value (HMO-POS) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare coverage and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $45 every three months. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other services such as meal benefits, annual wellness exams and screening mammography, and gFOBT and FIT are covered with no copay.
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