A non-government entity
Aetna Medicare Explorer Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Explorer Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Explorer Value (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Explorer Value (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southern NJ, Middlesex and Monmouth Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Aetna Medicare Explorer Value (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 Explorer Value (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 Explorer Value (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $450.00 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 $9350.00 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 Explorer Value (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 Explorer Value (HMO) plan has a $450 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance based on the drug tier and pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and mail order, but a $12 copay at standard pharmacies. For standard generic drugs, you'll pay 22% coinsurance, while preferred brand drugs have 25% coinsurance. Non-preferred drugs have 27% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Explorer Value (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $450. This plan covers primary care, mental health, and specialist visits with copays, as well as emergency, hearing, vision, and dental services. Preventive services are covered with no copay, and there is also coverage for home health, medical equipment, and diagnostic services. However, the plan does not cover cardiac rehabilitation services, and also has limitations on other services such as skilled nursing facility stays and home infusion services.
Inpatient Hospital See details
The Aetna Medicare Explorer Value (HMO) plan covers inpatient hospital stays, including acute and psychiatric care. For inpatient hospital-acute, you pay a $395 copay for days 1-6, and no copay for days 7-90. For inpatient hospital psychiatric, you pay a $339 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay, but non-Medicare covered stays and upgrades for inpatient hospital-acute are not covered. 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 with a copay ranging from $0 to $450. Observation services have a copay of $395. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay of $40 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $60 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Explorer Value (HMO) plan. This plan has a $300 copay for both ground and air ambulance services, and there is no 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 Explorer Value (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all have no coinsurance.
Primary Care See details
The Aetna Medicare Explorer Value (HMO) plan covers primary care physician services and chiropractic services with a $15 copay. Occupational therapy services have a $35 copay, while physician specialist services have a copay between $0 and $45. Mental health and psychiatric individual and group sessions have a $40 copay. Physical therapy and speech-language pathology services have a $35 copay, and other health care professionals have a copay between $0 and $45. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid treatment program services have a $40 copay. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Explorer Value (HMO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services such as Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Services not covered include In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Explorer Value (HMO) plan, including hearing exams with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Explorer Value (HMO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with no copay. Routine eye exams are covered with no copay, and other eye exam services are covered with no copay. Eyewear has a combined maximum of $150 per year, with contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all covered with no copay.
Dental Services See details
Dental Services with the Aetna Medicare Explorer Value (HMO) plan include coverage for Medicare Dental Services with a $45 copay, as well as Oral Exams, Dental X-Rays, and Prophylaxis (Cleaning) with no copay. Fluoride Treatment, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. 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, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage under the Aetna Medicare Explorer Value (HMO) plan includes Durable Medical Equipment (DME) with 0% to 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance, Medical Supplies with 0% to 20% coinsurance, and Diabetic Equipment with 0% to 20% coinsurance for Diabetic Supplies and 20% coinsurance for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $45, and lab services with no copay. Radiological services include a maximum copay of $350 for diagnostic services, a 20% coinsurance for therapeutic services, and a $45 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Explorer Value (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 not covered by the Aetna Medicare Explorer Value (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Explorer Value (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Explorer Value (HMO) plan's "Other Services" benefit provides a meal benefit with no copay, and covers annual wellness exams and screening mammography, as well as gFOBT and FIT, all with no copay. This plan does not cover acupuncture, over-the-counter items, or several other listed services.
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