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 Middle Tennessee. 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 $15.10. 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 $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:
Sign up for Aetna Medicare Value Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Value Plus (HMO) plan features an annual drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when filling prescriptions through a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options charge a copay ranging from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply duration. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy and mail-order channels. 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 services with clear, predictable costs. You will pay no copay for primary care doctor visits, while specialist visits range from no copay to a $35 copay. Inpatient hospital stays require a daily copay of $382 for the first eight days, and emergency room visits carry a $130 copay which is waived upon admission. Additionally, the plan features strong supplemental benefits, including routine dental, vision, and hearing exams with no copay. You also benefit from a $1,000 annual comprehensive dental limit with 20% to 50% coinsurance, a $175 annual eyewear allowance, and a $30 quarterly allowance for over-the-counter items. Skilled nursing care is covered with no coinsurance, requiring a low $10 daily copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital care under Aetna Medicare Value Plus (HMO) is covered with no coinsurance and requires prior authorization, with a $382 copay for days 1-8 of acute stays and a $292 copay for days 1-8 of psychiatric stays, followed by no copay for days 9-90. Some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Aetna Medicare Value Plus (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $382 copay and observation services with a $382 copay per stay. Ambulatory surgical center and outpatient blood services feature 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 for these covered services.
Ambulance and Transportation Services See details
Ambulance services are covered by Aetna Medicare Value Plus (HMO) and require prior authorization, featuring a $275 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by the Aetna Medicare Value Plus (HMO) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency services are covered up to a $250,000 lifetime maximum with no coinsurance and copays ranging from $130 to $275.
Primary Care See details
Aetna Medicare Value Plus (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $35 copay and no coinsurance. Covered physical, occupational, and speech therapies have a $30 copay and no coinsurance, whereas mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance. Podiatry and routine chiropractic care are not covered under these benefits.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (HMO), featuring no copay and no coinsurance for annual physical exams, fitness benefits, health education, and screenings, while kidney disease education has no copay but requires a 20% coinsurance. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Aetna Medicare Value Plus (HMO) covers hearing exams with no coinsurance, requiring a $35 copay for Medicare-covered exams and no copay for routine annual exams and fitting evaluations. Prescription hearing aids are partially covered up to $1,250 per ear annually with no copay or coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (HMO) covers vision services with no deductibles and no coinsurance, offering eye exams with a copay ranging from $0 to $35, which includes one annual routine exam at no copay. Covered eyewear also has no copay and features a combined maximum plan benefit of $175 every year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive exams, cleanings, and x-rays. Comprehensive dental services are covered up to a $1,000 annual limit with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or 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 chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from no coinsurance to 20%. Prior authorization is required for these services, 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. Outpatient diagnostic tests have no coinsurance and a $0 to $200 copay, lab services and outpatient X-rays have no copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (HMO) provides cardiac rehabilitation services with no coinsurance, but in practice, some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. Under this plan, you will pay a daily copayment of $10.00 for days 1 through 20 and $218.00 for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Aetna Medicare Value Plus (HMO) partially covers other services, offering no copay and no coinsurance for over-the-counter items up to $30 every three months and select annual wellness screenings. Acupuncture and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved