A non-government entity
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 South Carolina. This plan received an overall rating of 4 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 $23.90. 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 $250.00 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 $6750.00 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 a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For preferred generic drugs, you will pay a $10 copay at a preferred pharmacy, and $12 at a standard pharmacy or through standard mail order. For other tiers, you will pay coinsurance between 25% and 30%. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive coverage with a focus on outpatient services, preventive care, and dental services. The plan includes no copay for primary care physician services, routine hearing and eye exams, and many dental services. You'll pay a copay for inpatient hospital stays, emergency services, and specialist visits.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $374 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, you'll pay a $286 copay for days 1-8, and no copay for days 9-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by the Aetna Medicare Value Plus (HMO) plan. Outpatient hospital services have a copay between $0 and $374, while observation services have a $374 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and outpatient substance abuse services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (HMO) plan, but requires prior authorization. You will pay a $105 copay for this service.
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 $275 copay, while air ambulance services have a 20% coinsurance; 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 under the Aetna Medicare Value Plus (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have a maximum plan benefit coverage of $250,000 with a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay (routine care is not covered), Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $25 copay, and Mental Health Specialty Services with a $40 copay for individual and group sessions. Other covered benefits include Other Health Care Professional services with a copay between $0 and $25, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
The Aetna Medicare Value Plus (HMO) plan covers preventive services including an annual physical exam with no copay. Additional preventive services are covered, and other services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other services such as In-Home Safety Assessment, Personal Emergency Response System, and Weight Management Programs are not covered.
Hearing Services See details
The Aetna Medicare Value Plus (HMO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids (all types) are covered with no copay, but the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, or Prescription Hearing Aids - Over the Ear. The plan does not cover OTC hearing aids.
Vision Services See details
The Aetna Medicare Value Plus (HMO) plan covers vision services, including eye exams with a copay of $0-$25, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is covered with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum of $200 per year.
Dental Services See details
The Aetna Medicare Value Plus (HMO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay. The plan also covers prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 by the Aetna Medicare Value Plus (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Value Plus (HMO), including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Aetna Medicare Value Plus (HMO), including diagnostic procedures and tests with a copay between $0 and $120, and lab services with no copay. Radiological services include a copay for diagnostic and therapeutic services, and a 20% coinsurance for therapeutic services.
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 covered by the Aetna Medicare Value Plus (HMO) plan, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some services, but the exact amount is not specified.
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. You will have a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services in the Aetna Medicare Value Plus (HMO) plan includes coverage for Over-the-Counter (OTC) Items with no copay, a maximum benefit of $45 every three months, and a meal benefit with no copay, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. Other services covered include annual wellness exams, screening mammography, gFOBT, and FIT, all with no copay.
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