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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 Oklahoma City 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 $25.00. 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 $10100.00 (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 $10100.00 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 drug deductible of $615. You will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when filled through preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require a copay ranging from $2 to $6 for Tier 1 drugs and $12 to $36 for Tier 2 drugs, depending on the supply duration. For higher-tier prescriptions, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both incur a 25% coinsurance. These coinsurance rates apply equally to preferred and standard pharmacies, with Tier 5 specialty drugs limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including a low $5 copay for primary care visits and a $0 to $55 copay for specialists. For hospital care, inpatient acute stays require a $445 daily copay for the first six days, while outpatient hospital services range from no copay to a $375 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. In addition to core medical care, this plan provides valuable preventive and supplemental benefits with no copay or coinsurance, including annual physicals, routine eye exams, and preventive dental care. Prescription hearing aids are covered with no copay up to $1,000 per ear annually, and vision eyewear is covered up to a combined $100 annual limit. Other essential services like home health care and laboratory tests are fully covered with no copay or coinsurance, helping you easily manage your healthcare budget.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $445 daily copay for days 1 to 6 (no copay for days 7 and beyond with unlimited additional days), while psychiatric stays require a $375 daily copay for days 1 to 6 (no copay for days 7 to 90). This benefit is partially covered, as 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 ambulatory surgical center and blood services which also feature no copay. Outpatient hospital services require a $0 to $375 copay, observation services require a $445 copay per stay, and outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services under Aetna Medicare Value Plus (PPO) are partially covered, with ground ambulance services requiring a $335 copay and air ambulance services requiring a 20% coinsurance, both subject to prior authorization. Non-emergency transportation services to plan-approved or any 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, with no coinsurance required for either service. Worldwide emergency and urgent care are also covered with a $130 copay, while worldwide emergency transportation has a $335 copay, featuring no coinsurance up to a $250,000 maximum benefit limit.
Primary Care See details
Aetna Medicare Value Plus (PPO) covers primary care visits for a $5 copay and specialist visits for no copay to a $55 copay, both with no coinsurance, while telehealth services require a 20% coinsurance and no copay to a $55 copay. Other services like physical therapy and mental health sessions have a $45 copay and no coinsurance, though podiatry is not covered, and chiropractic benefits are only partially covered with routine and other chiropractic services excluded.
Preventive Services See details
Preventive services are partially covered under the Aetna Medicare Value Plus (PPO) plan, offering no copay and no coinsurance for annual physicals, glaucoma screenings, and fitness benefits, while kidney disease education requires a 20% coinsurance and no copay. However, several services are not covered, including in-home safety assessments, personal emergency response systems, weight management, and alternative therapies.
Hearing Services See details
Aetna Medicare Value Plus (PPO) offers partially covered hearing services, featuring Medicare-covered exams for a $55 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $1,000 per ear annually with no copay or coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered under the Aetna Medicare Value Plus (PPO) with no copay, no coinsurance, and no deductible for eye exams and eyewear. The plan includes one routine eye exam per year with a $50 annual maximum, and offers a combined $100 annual maximum for contacts, eyeglasses, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (PPO) offers partially covered dental services, featuring no copay and no coinsurance for preventive care like cleanings and exams, and a $55 copay with no coinsurance for Medicare-covered dental. Comprehensive services have no copay and 20% to 50% coinsurance up to a $500 annual limit, while fluoride, implants, maxillofacial prosthetics, other diagnostic/preventive services, and orthodontics 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 and step therapy are required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the 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, including durable medical equipment (DME) and diabetic supplies, with no copays and coinsurance ranging from no coinsurance up to 20%. Prosthetic devices are covered with no copay and 20% coinsurance, and diabetic therapeutic shoes or inserts are available with no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Plus (PPO), with prior authorization required for most services. Lab services feature no copay or coinsurance, diagnostic tests range from no copay to a $50 copay with no coinsurance, and radiological services range from a $5 copay for X-rays to a 20% coinsurance for therapeutic radiation.
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 for these services.
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. Sub-services including cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, 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 for an annual wellness exam, screening mammographies, additional gFOBT and FIT, and up to $15 every three months in reimbursed over-the-counter (OTC) items. Acupuncture and meal benefits are not covered.
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