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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 Tulsa 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 $15.00. 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 $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:
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Drug Coverage
The Aetna Medicare Value Plus (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options require a copay, starting at $2 for Tier 1 and $12 for Tier 2 for a one-month supply. Higher-tier medications require coinsurance instead of flat copays, with Tier 3 preferred brand drugs costing 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance rate. Specialty medications are limited to a one-month supply, whereas other tiers offer one, two, or three-month supply options.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers affordable coverage with no copay for primary care visits, annual physical exams, and home health care. For emergency and acute medical needs, emergency room visits require a $130 copay, while inpatient hospital stays incur a $280 daily copay for the first six days. Diagnostic lab work, outpatient X-rays, and ambulatory surgical services are also covered with no copay and no coinsurance. This plan also provides valuable dental, vision, and hearing benefits to help lower your out-of-pocket costs. Routine vision and hearing exams feature no copay, alongside a $200 annual eyewear allowance and a $1,250 per-ear prescription hearing aid benefit. Preventive dental cleanings and exams have no copay, while comprehensive dental services are covered up to a $2,000 annual maximum with 20% to 50% coinsurance.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) covers inpatient hospital services with no coinsurance, requiring a $280 daily copay for days 1 through 6 of acute stays and a $375 daily copay for days 1 through 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and 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, featuring outpatient hospital copays from $0 to $350 and observation services at a $280 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (PPO) covers partial hospitalization services with copays of either $85.00 or $145.00 and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ambulance services with a $340 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport, both of which require prior authorization. Some transportation services are covered, but trips to plan-approved or any 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, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency services are covered up to a $250,000 limit with no coinsurance and copays of $130 for emergency or urgent care and $340 for emergency transportation.
Primary Care See details
Aetna Medicare Value Plus (PPO) features primary care doctor visits with no copay and no coinsurance, and specialist visits with a $0 to $40 copay and no coinsurance. Outpatient therapies, psychiatric, and mental health services generally carry a $40 copay and no coinsurance, while chiropractic and podiatry services are not covered. Telehealth options are also available with a $0 to $50 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO), offering no copay and no coinsurance for annual physical exams, health education, and glaucoma screenings, while kidney disease education requires a 20% coinsurance and no copay. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, 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/bathroom safety devices, and counseling.
Hearing Services See details
Hearing Services are partially covered by Aetna Medicare Value Plus (PPO), offering Medicare-covered exams for a $40 copay and no coinsurance, and annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered with no copay and no coinsurance up to a $1,250 annual limit per ear, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear 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 both eye exams and eyewear. This coverage includes one routine eye exam per year with a $50 annual limit and a $200 yearly allowance for eyeglasses, frames, lenses, and contact lenses with no deductibles.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (PPO), featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care like cleanings, exams, and x-rays. Comprehensive services, including endodontics and periodontics, are covered with no copay and 20% to 50% coinsurance up to a $2,000 annual maximum, though fluoride, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin carries 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) 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, prosthetics, medical supplies, and diabetic services, with no copays. Coinsurance ranges from no coinsurance up to 20% depending on the specific item, and prior authorization is required.
Diagnostic and Radiological Services See details
Aetna Medicare Value Plus (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, no copay for lab work, and a $0 to $50 copay for tests, while radiological services include no copay for outpatient X-rays and a minimum 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Plus (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Aetna Medicare Value Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under the Aetna Medicare Value Plus (PPO) plan are partially covered, offering no copay and no coinsurance for over-the-counter (OTC) items up to $15 every three months, annual wellness exams, screening mammographies, and select colon cancer screenings. However, acupuncture and meal benefits are not covered under this plan.
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