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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 Dallas and Surrounding Counties. 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) plan features an annual prescription drug deductible of $615. For generic medications, members enjoy no copay on Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail-order options, Tier 1 copays range from $2 to $6, while Tier 2 copays range from $12 to $36 depending on the supply. For higher-tier medications under this plan, cost-sharing transitions to coinsurance rather than flat copays. Tier 3 (Preferred Brand) drugs require a 22% coinsurance across all pharmacy and mail-order options, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications require a 25% coinsurance. Note that Tier 5 specialty drugs are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist visits range from no copay to a $35 copay. For hospital stays, inpatient care requires a $450 daily copay for the first six days with no coinsurance, whereas emergency room visits carry a $130 copay. Outpatient services and diagnostic tests are widely covered, with many services requiring no copay or copays up to $50. This plan also includes valuable supplemental benefits such as routine vision and preventive dental care with no copay or coinsurance, alongside a $1,000 annual limit for comprehensive dental services with 20% to 50% coinsurance. Routine hearing exams are available with no copay, and the plan provides up to $500 per ear annually for prescription hearing aids. Additionally, home health services feature no copay or coinsurance, and durable medical equipment is covered with up to 20% coinsurance and no copays.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient acute hospital stays with no coinsurance and a $450 daily copay for days 1 through 6, followed by no copay for additional days. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $300 daily copay for days 1 through 6, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $300 copay ($415 per stay for observation services), and outpatient substance abuse services have a $35 copay per session.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization benefits with no coinsurance, though prior authorization is required. Depending on the specific service, you will pay a copay of either $70.00 or $145.00.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Aetna Medicare Value Plus (PPO), which features ground ambulance services for a $295 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay, both requiring prior authorization. Transportation services to plan-approved or any other health-related locations are not covered by this plan.
Emergency Services See details
Aetna Medicare Value Plus (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services are covered up to $250,000 with no coinsurance and copays ranging from $130 to $295.
Primary Care See details
Aetna Medicare Value Plus (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Most therapy, psychiatric, and mental health services require a $35 copay and no coinsurance, while telehealth is available with a $0 to $50 copay and 20% coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive Services under the Aetna Medicare Value Plus (PPO) plan are largely covered with no copay and no coinsurance, though kidney disease education requires a 20% coinsurance with no copay. Additional preventive benefits are partially covered, excluding in-home safety assessments, 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
Hearing services under Aetna Medicare Value Plus (PPO) are partially covered, offering Medicare-covered exams for a $35 copay and no coinsurance, and annual routine exams and fittings with no copay or coinsurance. Prescription hearing aids are covered with no copay or coinsurance up to $500 per ear annually, but OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) offers vision services with no copay and no coinsurance for routine and Medicare-covered eye exams, allowing one routine exam per year up to a $50 maximum. Covered eyewear, including contact lenses, eyeglasses, and upgrades, also features no copay and no coinsurance up to a combined annual maximum of $100.
Dental Services See details
Aetna Medicare Value Plus (PPO) partially covers dental services, offering preventive exams, cleanings, and x-rays with no copay and no coinsurance, alongside Medicare-covered dental care for a $35 copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $1,000 yearly limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance.
Dialysis Services See details
Aetna Medicare Value Plus (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment with no copays for durable medical equipment (DME), medical supplies, and diabetic therapeutic shoes. Depending on the item, coinsurance ranges from no coinsurance up to 20% for DME, medical supplies, and diabetic supplies, while prosthetic devices require a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO) with prior authorization required. Lab services, outpatient X-rays, and diagnostic radiological services have no copay, while diagnostic procedures and tests carry a $0 to $50 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
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 covered by Aetna Medicare Value Plus (PPO) with no coinsurance; however, only some services are covered, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered and require copays ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services, offering over-the-counter items up to fifteen dollars every three months, annual wellness exams and screening mammographies, and additional gFOBT and FIT screenings with no copay and no coinsurance. Acupuncture, meal benefits, and certain other services are not covered.
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