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Aetna Medicare Value Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (PPO). 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 (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Bexar and Comal counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Plus (PPO) 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 (PPO).
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 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 $590.00 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 combined Maximum Out-Of-Pocket cost of $9550.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred generic drugs, you will have no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance. 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 (PPO) plan offers a range of benefits with varying costs. It includes coverage for inpatient and outpatient hospital services, with copays ranging from $0 to $375. The plan also provides coverage for various services like primary care, preventive care, hearing, vision, and dental, often with no copay or a low copay. This plan covers emergency services, ambulance services, and home health services. Additionally, it offers coverage for medical equipment, dialysis, and diagnostic services, with some services subject to coinsurance or copays. However, certain services like cardiac rehabilitation and some "Other Services" are not covered by this plan.
Inpatient Hospital See details
The Aetna Medicare Value Plus (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $375 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute, and all services for Non-Medicare-covered Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $275, observation services with a $365 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan. There is a $70 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Value Plus (PPO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance, and transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value Plus (PPO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $55 copay with no coinsurance, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation, all with no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, while chiropractic services have a $15 copay. Occupational therapy services have a $40 copay, and physical therapy and speech-language pathology services have a $40 copay. Physician specialist services have a copay between $0 and $35, and mental health and psychiatric services have a $35 copay for both individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55. Opioid treatment program services have a $35 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Other covered services include health education, wigs for hair loss, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay.
Hearing Services See details
Aetna Medicare Value Plus (PPO) covers hearing exams for a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per ear every year, and prescription hearing aids (all types) have no copay for 2 visits every year.
Vision Services See details
Vision Services are covered by the Aetna Medicare Value Plus (PPO) plan. Eye exams and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay.
Dental Services See details
Dental Services include coverage for Medicare dental services with a $35 copay, oral exams with no copay, dental X-rays with no copay, and prophylaxis (cleaning) with no copay. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with coinsurance between 20% and 50%, with other details described in the plan. Fluoride Treatment, 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 (PPO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a coinsurance of 0% to 20%, and Diabetic Supplies have a coinsurance of 0% to 20% with no copay; however, Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Value Plus (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $40, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of up to $325, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, but 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 Value Plus (PPO) plan. The plan does not cover any of the sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (PPO), but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan's "Other Services" benefit covers over-the-counter items with no copay, and has a maximum plan benefit coverage amount of $75.00 every three months. Acupuncture, meal benefits, 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, and Self-Directed Personal Assistance Services are not covered.
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