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 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 South Carolina. 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 $22.30. 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 $8200.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when utilizing preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply length. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy options. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a 1-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive coverage for core medical needs, including primary care doctor visits and annual physicals with no copay. Specialist visits require no copay to a $40 copay, while emergency room services carry a $115 copay that is waived upon hospital admission. For hospital care, inpatient stays require a $388 daily copay for the first seven days, with no copay for subsequent days. In addition to medical care, the plan provides robust dental, vision, and hearing benefits, featuring no copay for routine exams and a $30 quarterly allowance for over-the-counter items. Prescription hearing aids are covered up to $1,250 per ear annually with no copay, while eyewear is covered up to $175 annually with no copay or coinsurance. Comprehensive dental services carry a 20% to 50% coinsurance up to a $1,000 limit, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Value Plus (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $388 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $260 daily copay for days 1-8 and no copay for days 9-90. Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under the Aetna Medicare Value Plus (HMO) are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from no copay to $388, observation services require a $388 copay per stay, and outpatient substance abuse sessions carry a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO) covers partial hospitalization services with a copay of $105.00 or $110.00 and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Value Plus (HMO), featuring a $275 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Plus (HMO) for a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $275.
Primary Care See details
Aetna Medicare Value Plus (HMO) covers primary care doctor visits with no copay and no coinsurance, and specialist visits with no copay to a $40 copay and no coinsurance. Physical, occupational, and speech therapies require a $30 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (HMO), offering no copay and no coinsurance for annual physicals, glaucoma screenings, diabetes training, and fitness benefits. Kidney disease education is covered with no copay and a 20% coinsurance, though services like weight management, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Aetna Medicare Value Plus (HMO) partially covers hearing services, offering Medicare-covered exams for a $40 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services covered by Aetna Medicare Value Plus (HMO) include eye exams with no coinsurance and a copay ranging from no copay up to $40, with routine and follow-up diabetic exams having no copay. Eyewear is also covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $175 annually.
Dental Services See details
Aetna Medicare Value Plus (HMO) offers partially covered dental services, with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive cleanings, exams, and x-rays. Covered comprehensive services like restorative care, endodontics, periodontics, prosthodontics, and oral surgery have no copay and 20% to 50% coinsurance up to a $1,000 annual limit. Other diagnostic services, fluoride, other preventive services, maxillofacial prosthetics, implants, and orthodontics 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 and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (HMO), with prior authorization required for most items. Durable medical equipment and medical supplies feature no copay and no coinsurance to 20% coinsurance, prosthetics require no copay and 20% coinsurance, and diabetic therapeutic shoes and inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services covered by Aetna Medicare Value Plus (HMO) require prior authorization and feature no coinsurance with a $0 to $200 copay for diagnostic tests, and no copay for lab services. Diagnostic radiological services have a copay starting at $0, outpatient X-rays have no copay, and therapeutic radiological services carry a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by 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 coinsurance under the Aetna Medicare Value Plus (HMO), but only some services are covered in practice. Specifically, Cardiac Rehabilitation ($20 copay), Intensive Cardiac Rehabilitation ($20 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for PAD ($20 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance and prior authorization required, allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Value Plus (HMO) with no copay and no coinsurance, including an annual wellness exam, screening mammography, additional colorectal screenings, and a $30 quarterly over-the-counter allowance. However, acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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