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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 Austin. 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 generics and Tier 2 generics when using a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply fill. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy channels. Tier 5 specialty drugs also carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage featuring no copay for primary care visits, home health services, and routine preventive care. For hospital stays, members pay no coinsurance, though inpatient acute care requires a daily copay of $315 for the first six days. Emergency services carry a $130 copay, which is waived if admitted, while urgent care visits require a $50 copay. This plan also includes valuable dental, vision, and hearing benefits, offering no copay for routine eye exams, eyewear, and preventive dental cleanings. Prescription hearing aids are covered up to $500 per ear annually, and comprehensive dental services are covered up to a $2,000 yearly limit with 20% to 50% coinsurance. Additionally, diagnostic lab tests and outpatient X-rays require no copay, while medical equipment and Part B drugs carry coinsurance ranging up to 20%.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $315 for days 1 to 6 of acute care and $375 for days 1 to 6 of psychiatric care, with no copay for remaining covered days. This benefit is partially covered because 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, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services carry a copay of $0 to $350 ($300 per stay for observation services), and outpatient substance abuse sessions have a $40 copay, with prior authorization required for several of these services.
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 services are covered by Aetna Medicare Value Plus (PPO) and require prior authorization, costing a $300 copay with no coinsurance for ground transport and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Plus (PPO) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 lifetime limit with no coinsurance and copays ranging from $130 to $300.
Primary Care See details
Aetna Medicare Value Plus (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $0 to $70 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with a $40 copay and no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by Aetna Medicare Value Plus (PPO) with no copay and no coinsurance for annual physical exams, fitness benefits, and various screenings, though kidney disease education requires a 20% coinsurance and no copay. This benefit is partially covered, as sub-services like in-home safety assessments, personal emergency response systems, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by Aetna Medicare Value Plus (PPO), which features routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $45 copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay or coinsurance, though OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (PPO) with no copay and no coinsurance for eye exams and eyewear. This includes a $50 annual limit for eye exams, including one routine exam per year, and a combined $175 annual allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (PPO) offers partially covered dental services, featuring Medicare-covered dental with a $45 copay and no coinsurance, and preventive cleanings and exams for no copay and no coinsurance. Comprehensive services are covered up to a $2,000 annual maximum with no copay and 20% to 50% coinsurance, though fluoride, implants, orthodontics, maxillofacial prosthetics, and select diagnostic and preventive services are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Plus (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Value Plus (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Aetna Medicare Value Plus (PPO) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, with no copays and coinsurance ranging from no coinsurance up to 20%. Prior authorization is required for these services, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Aetna Medicare Value Plus (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $50 copay for diagnostic procedures. Covered radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiological services with a $0 minimum copay, and therapeutic radiological services with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (PPO) offers cardiac rehabilitation benefits with no coinsurance, though only some services are covered because cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) are not covered. These non-covered services require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, featuring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior 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 with no copay and no coinsurance, which includes annual wellness exams, screening mammographies, and up to $15 every three months for reimbursed over-the-counter items. Acupuncture and meal benefits are not covered.
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