A non-government entity
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 Harris County. 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 $8950.00 (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 $8950.00 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:
Sign up for Aetna Medicare Value Plus (PPO)
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 Value Plus (PPO) plan features an annual drug deductible of $615. For prescription drugs, this plan offers no copay on Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when filled at a preferred pharmacy or through preferred mail order. If you use standard pharmacies or standard mail order, Tier 1 drugs carry a low copay starting at $2, while Tier 2 drugs start at a $12 copay for a one-month supply. Higher-tier medications require coinsurance rather than flat copays under this plan. Tier 3 (Preferred Brand) drugs have a 22% coinsurance, while Tier 4 (Non-Preferred Drug) and Tier 5 (Specialty Tier) medications both require 25% coinsurance for all pharmacy and mail-order options. These percentage-based costs apply equally whether you choose preferred or standard network pharmacies.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers affordable coverage options with no copays for primary care physician visits, routine annual physicals, and preventive dental cleanings. For inpatient hospital stays, members pay no coinsurance and a $450 daily copay for the first six days, after which additional days are covered with no copay. Outpatient specialist visits are also highly affordable, ranging from no copay up to a $50 copay. This plan also features valuable extra benefits, including routine eye and hearing exams with no copays and no coinsurance. Members receive a $125 annual eyewear allowance and up to $500 per ear annually for prescription hearing aids. Additionally, the plan covers home health services with no copay and provides a $15 over-the-counter item allowance every three months.
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 to 6, followed by no copay for unlimited additional days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $375 daily copay for days 1 to 6, then no copay for days 7 to 90, but additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $400, observation services require a $450 copay per stay, and outpatient substance abuse sessions have 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 services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Aetna Medicare Value Plus (PPO), featuring a $300 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
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, urgent, and transportation services are also covered with no coinsurance and copays ranging from $130 to $300, subject to a $250,000 maximum plan benefit limit.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $50 copay and no coinsurance. Physical, occupational, speech, and mental health therapies require a $40 copay and no coinsurance, telehealth services have a $0 to $50 copay and 20% coinsurance, and podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO) with no copay and no coinsurance for annual physicals, screenings, and health education, though kidney disease education requires a 20% coinsurance and no copay. Uncovered services include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission 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
Aetna Medicare Value Plus (PPO) offers partially covered hearing services, including annual routine exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams have a $50 copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear yearly with no copay and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered by Aetna Medicare Value Plus (PPO) with no copay, no coinsurance, and no deductible for both eye exams and eyewear. This benefit includes one routine eye exam per year up to a $50 limit, alongside a $125 combined annual maximum allowance for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (PPO), offering Medicare-covered dental for a $50 copay and no coinsurance, and preventive services like cleanings and exams with no copay and no coinsurance. Comprehensive services have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Under this plan, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy, radiation, and other Part B drugs range from no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) with no copay and a 20% coinsurance, subject to prior authorization requirements.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and coinsurance ranging from 0% (no coinsurance) to 20%. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Plus (PPO), requiring prior authorization for all services. Diagnostic procedures have no coinsurance and a $0 to $50 copay, lab services and outpatient X-rays have no copay, diagnostic radiology copays start at $0, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, although only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and carry copayments 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 $10 copay per day for days 1 through 20 and a $218 copay per day for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services with no copay and no coinsurance, including annual wellness exams, screening mammography, additional gFOBT and FIT screenings, and over-the-counter items up to $15 every three months. Acupuncture and meal benefits are not covered under this plan.
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