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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 Greensboro, Winston-Salem NC 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 $32.20. 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 a drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will enjoy no copay when using a preferred pharmacy or preferred mail order. If you utilize standard pharmacies or standard mail order, copays start at $2.00 for Tier 1 and $12.00 for Tier 2. Higher-tier medications under this plan require coinsurance instead of flat copays. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for both Tier 4 non-preferred drugs and Tier 5 specialty drugs. These coinsurance rates remain the same whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive medical coverage with no copay for primary care visits and low copays ranging from no copay to $30 for specialist visits. For hospital stays, members pay daily copays for the first eight days of inpatient care with no copay for additional days, while outpatient hospital services feature a copay of up to $382 with no coinsurance. Emergency care is available with a $130 copay, and urgent care has a $50 copay, both with no coinsurance. This plan also includes valuable dental, vision, and hearing benefits, featuring no copays for routine eye exams, preventive dental cleanings, and routine hearing exams. Prescription hearing aids are covered up to $1,250 per ear annually with no copay, and comprehensive dental services require a 20% to 50% coinsurance up to a $1,500 annual limit. Additionally, members benefit from no copays on durable medical equipment and an over-the-counter item allowance of up to $30 every three months.
Inpatient Hospital See details
Aetna Medicare Value Plus (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $382 daily copay for days 1-8 and no copay for days 9 and beyond, while psychiatric stays require a $292 daily copay for days 1-8 and no copay for days 9-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (HMO) covers outpatient services with no coinsurance, featuring a $0 to $382 copay for outpatient hospital services and a $382 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered 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 services with a copay of $140.00 or $145.00 and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Value Plus (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are covered with a $130 copay, and worldwide emergency transportation has a $275 copay, both featuring no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Value Plus (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay with no coinsurance, while mental health, psychiatric, and opioid treatments carry a $40 copay with no coinsurance. Some chiropractic services are covered but routine and other chiropractic services are not covered, podiatry is not covered, and telehealth benefits have a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Aetna Medicare Value Plus (HMO) provides partially covered preventive services, offering no copay and no coinsurance for annual physical exams, health education, and diabetes training, while kidney disease education has no copay and a 20% coinsurance. Specific sub-services are not covered, such as medical nutrition therapy, weight management programs, and personal emergency response systems.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (HMO), with Medicare-covered exams requiring a $30 copay and no coinsurance, while routine exams and fitting evaluations have no copay or coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services covered by Aetna Medicare Value Plus (HMO) include routine eye exams and eyewear with no copay and no coinsurance, up to a $200 annual maximum. Medicare-covered eye exams have a copay ranging from $0 to $30 with no coinsurance, and there is no deductible for any vision services.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and x-rays. Comprehensive services have no copay and 20% to 50% coinsurance up to a $1,500 annual limit, but fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Value Plus (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have 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, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (HMO) with no copay for durable medical equipment (DME), prosthetics, and diabetic supplies. Coinsurance ranges from no coinsurance to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices require a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (HMO), requiring prior authorization for all services. Diagnostic services feature no coinsurance, with no copay for lab tests and a copay ranging from no copay to $200 for other diagnostic procedures. Radiological services carry a minimum 20% coinsurance plus a copay for therapeutic services, coinsurance with no copay for outpatient X-rays, and no copay for diagnostic radiology.
Home Health Services See details
Home health services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered with no copay and no coinsurance under the Aetna Medicare Value Plus (HMO). While some services are covered, specific benefits including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
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 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not needed for admission, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other Services are partially covered by Aetna Medicare Value Plus (HMO), offering no copay and no coinsurance for annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and over-the-counter (OTC) items up to $30 every three months. However, acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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