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 Southeast Non-Metro 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 $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:
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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Standard pharmacies and standard mail order options are also available with low copays starting at $2 for Tier 1 and $12 for Tier 2. Brand name and specialty medications require coinsurance rather than flat copays. Tier 3 preferred brand drugs incur a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy types. Specialty tier prescriptions are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits, home health services, and annual physical exams. Specialist visits range from no copay to a $65 copay, while inpatient hospital stays require a daily copay of $440 for the first six days with no coinsurance. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care services require a $50 copay. For supplemental care, the plan features no copay for routine vision and hearing exams, alongside helpful allowances of up to $125 annually for eyewear and $500 per ear for hearing aids. Preventive dental care is also available with no copay, while comprehensive dental services require a 20% to 50% coinsurance up to a $1,000 yearly limit. Members also benefit from no copay on laboratory services and outpatient X-rays, plus a $15 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Aetna Medicare Value Plus (PPO) with no coinsurance, although prior authorization is required. For acute stays, you will pay a $440 daily copay for days 1 through 6 and no copay for additional days, while psychiatric stays require a $300 daily copay for days 1 through 6 and no copay for days 7 through 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (PPO) covers outpatient hospital services with a $0 to $350 copay and no coinsurance, and outpatient observation services with a $400 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a $50 copay and no coinsurance.
Partial Hospitalization See details
The Aetna Medicare Value Plus (PPO) plan covers partial hospitalization services with a copay of either $70.00 or $145.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ground ambulance services with a $340 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all ambulance services. Transportation services to health-related locations are not covered under this plan.
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 featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance up to a $250,000 maximum limit, with copays ranging from $130 to $340 depending on the service.
Primary Care See details
Primary care benefits under the Aetna Medicare Value Plus (PPO) feature no copay and no coinsurance for primary care doctor visits, and a $0 to $65 copay with no coinsurance for specialists. Physical, occupational, and mental health therapies require a $50 copay with no coinsurance, while telehealth services have a $0 to $65 copay and 20% coinsurance; notably, podiatry is not covered, and chiropractic services are only partially covered because routine chiropractic care is excluded.
Preventive Services See details
Preventive Services are partially covered by Aetna Medicare Value Plus (PPO), with most covered services—including annual physical exams, glaucoma screenings, and fitness benefits—offering no copay and no coinsurance. Kidney disease education is covered with no copay and a 20% coinsurance, though several supplemental benefits like in-home safety assessments, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Aetna Medicare Value Plus (PPO) offers partially covered hearing services, featuring Medicare-covered exams for a $65 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to $500 per ear annually with no copay and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Plus (PPO) covers vision services with no copay and no coinsurance for eye exams and eyewear. This includes one routine eye exam per year up to a $50 maximum and a $125 annual combined allowance for contact lenses, eyeglasses, frames, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (PPO) dental services are partially covered, offering preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $65 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 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 benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (PPO) with no copays, though prior authorization is required for most items. Durable medical equipment, medical supplies, and diabetic supplies feature no coinsurance to 20% coinsurance, while prosthetic devices require a 20% coinsurance and diabetic therapeutic shoes or inserts have no copay.
Diagnostic and Radiological Services See details
Aetna Medicare Value Plus (PPO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays, and copays from $0 to $40 for diagnostic procedures with no coinsurance. Diagnostic radiological services feature copays starting at $0, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by the Aetna Medicare Value Plus (PPO) with no copay and no coinsurance. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered under the Aetna Medicare Value Plus (PPO) with no coinsurance, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Copayments for these excluded rehabilitation services range from $15 to $25 depending on the specific service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while the plan does not require a prior three-day inpatient hospital stay for admission, additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
Aetna Medicare Value Plus (PPO) partially covers other services with no copay and no coinsurance for covered benefits, which include a $15 quarterly over-the-counter (OTC) item allowance, annual wellness exams, and additional colorectal cancer screenings. Acupuncture, meal benefits, and certain other services 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