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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 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 Middle Tennessee. 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 $9.00. 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 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, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. The coinsurance for standard generic drugs is 25%, and preferred brand drugs have a 26% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services may have copays depending on the service. The plan covers primary care, preventive, hearing, vision, and dental services. The plan also includes benefits like ambulance services, emergency services, and home health services, with copays or coinsurance depending on the specific service. Additional benefits include home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a copay of $374 for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, you pay a copay of $286 for days 1-8, and no copay for days 9-90. Additional Days for Inpatient Hospital-Acute is covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $374, observation services have a $374 copay, and individual and group outpatient substance abuse sessions have a copay between $40 and $40. Ambulatory Surgical Center (ASC) services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO) plan, but requires prior authorization. You will have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (HMO) plan, including ground ambulance services with a $275 copay and air ambulance services with 20% coinsurance. Transportation services to health-related locations 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Transportation has a $275 copay; all have no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $15 copay for Chiropractic Services (though Routine Care is not covered), and a $30 copay for Occupational Therapy Services. Physician Specialist Services have a $25 copay, while Mental Health Specialty Services and Psychiatric Services have a $40 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Other Health Care Professional services have a copay between $0-$25. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0-$45. Opioid Treatment Program Services have a $40 copay.
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 specific services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies may have a copay. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered. The plan also covers kidney disease education services with a 20% coinsurance, and other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum benefit of $1250 per year. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (HMO) plan covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay and a combined maximum benefit of $200 every year. Routine eye exams are covered with no copay, and you are eligible for 1 exam every year.
Dental Services See details
The Aetna Medicare Value Plus (HMO) plan covers Medicare Dental Services with a $25 copay and other dental services, including oral exams, dental x-rays, and other diagnostic dental services, with no copay. This plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but does not cover maxillofacial prosthetics, implant services, or orthodontics. This plan has a maximum benefit of $2,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring 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 with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, are covered. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, Medical Supplies have a coinsurance between 0% and 20%, and Diabetic Supplies have a coinsurance between 0% and 20%. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $14 copay.
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 technically covered, but the plan does not cover any of the sub-services, so in practice, this benefit is not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO) plan. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO) plan does not cover 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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, Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and meal benefits are covered with no copay, and other services such as annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay.
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