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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 2026, 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 San Antonio. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $4.80. 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 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) prescription drug plan has an annual deductible of $615. For Tier 1 preferred generics and Tier 2 generics, you will have no copay when filling prescriptions through preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require a copay starting at $2.00 for Tier 1 and $12.00 for Tier 2. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a 1-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage with no copays for primary care physician visits, preventive services, and home health care. Specialist visits feature a low copay ranging from $0 to $40, while inpatient hospital stays require a $375 daily copay for the first five days followed by no copay for days six through 90. Emergency care is available with a $130 copay, which is waived if admitted to the hospital within 24 hours. This plan also includes supplemental benefits, featuring no copays or coinsurance for routine vision exams, preventive dental care, and routine hearing tests. Members receive a $150 annual eyewear allowance, a $500 annual hearing aid allowance per ear, and a $45 quarterly allowance for over-the-counter items. Additionally, skilled nursing facility stays are covered with a $10 daily copay for the first 20 days and no coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) inpatient hospital care is partially covered with no coinsurance and requires prior authorization. For both acute and psychiatric stays, you pay a $375 daily copay for days 1 through 5 and no copay for days 6 through 90, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which also have no copay. Outpatient hospital services require a copay ranging from $0 to $375, observation services have a $375 copay per stay, and outpatient substance abuse sessions incur a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Value Plus (PPO), featuring a $290 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency services are also covered up to a $250,000 maximum benefit with no coinsurance, featuring a $130 copay for emergency and urgent care, and a $290 copay for emergency transportation.
Primary Care See details
Aetna Medicare Value Plus (PPO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Most other covered services, such as physical therapy, mental health, and psychiatric services, carry a $40 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO), featuring no copay and no coinsurance for most services like annual physical exams and health education. Kidney disease education is covered with no copay and a 20% coinsurance, but several supplemental services, such as in-home safety assessments, personal emergency response systems, and nutritional benefits, are not covered.
Hearing Services See details
Aetna Medicare Value Plus (PPO) partially covers hearing services, offering Medicare-covered exams for a $40 copay and no coinsurance, and routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are covered by the Aetna Medicare Value Plus (PPO) with no copays, no coinsurance, and no deductibles for exams and eyewear. This benefit provides one routine eye exam per year up to a $50 maximum, plus a $150 annual combined allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (PPO) partially covers dental services, offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive services like oral exams, cleanings, and X-rays with no copay and no coinsurance. However, several sub-services are not covered, including fluoride, restorative treatments, endodontics, periodontics, prosthodontics, implants, and oral surgery.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, though prior authorization and step therapy may apply. Associated Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by Aetna Medicare Value Plus (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment with no copay for durable medical equipment (DME), medical supplies, prosthetics, and diabetic therapeutic shoes. Coinsurance ranges from no coinsurance to 15% for DME, no coinsurance to 20% for medical and diabetic supplies, and is 20% for prosthetic devices.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO) with prior authorization required. Lab services have no copay and no coinsurance, diagnostic procedures and tests have a $0 to $40 copay with no coinsurance, and radiological services range from no copay with coinsurance for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Value Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Plus (PPO) plan. This includes no coverage for intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Aetna Medicare Value Plus (PPO) plan, featuring no copay and no coinsurance for over-the-counter (OTC) items up to $45 every three months, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
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