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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 Dallas and Surrounding 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 meeting your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For generic drugs in the preferred pharmacy, you will have no copay, but in the standard pharmacy, the copay is $12. Brand name and non-preferred drugs will have 25% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care visits, many preventive services, and routine vision and hearing services, as well as certain dental services. The plan also includes coverage for home health services, with no copay, and skilled nursing facility services, with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $410 copay for days 1-6, and no copay for days 7-90, and Inpatient Hospital Psychiatric, with a $300 copay for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, with a copay between $0 and $275, observation services with a $335 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, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (PPO). Ground ambulance services have a $245 copay, while air ambulance services have a 20% 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 by the Aetna Medicare Value Plus (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage and a $245 copay for Worldwide Emergency Transportation, with no coinsurance for any of the services.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $15 copay for routine care, and Occupational Therapy Services have a $40 copay. Physician Specialist Services have a copay between $0 and $35, and Individual and Group Sessions for both Mental Health and Psychiatric Services have a $35 copay. Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a copay between $0 and $55 with 20% coinsurance. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services include an annual physical exam, with no copay. Other preventive services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy are covered, but may have a copay. Kidney Disease Education Services are covered with 20% coinsurance. Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per ear, per year.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum benefit of $290 every year.
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, prophylaxis (cleaning) with no copay, restorative services with 20% to 50% coinsurance, adjunctive general services with 20% to 50% coinsurance, endodontics with 20% coinsurance, periodontics with 20% to 50% coinsurance, prosthodontics (removable) with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with 20% to 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, with a coinsurance between 0% and 20% for Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $50, and Lab Services with no copay. Outpatient X-Ray Services have no copay, and Diagnostic Radiological Services have a copay up to $325. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (PPO) 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 Value Plus (PPO) plan. The plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (PPO) plan. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered SNF 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 offers a maximum benefit of $75 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. Other 1 and Other 2 benefits are covered with no copay.
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