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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may pay $15.00 for Part D drugs. Always check the plan's formulary for specific drug coverage details.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers a variety of benefits with varying costs. You can expect no copay for primary care visits, eye exams, and many preventive services. For hospital stays, you'll pay a copay, which varies depending on the service and length of stay. The plan also covers outpatient services, hearing, and dental. Outpatient services have a copay between $0 and $300, while hearing exams and hearing aids have no copay. Dental services include oral exams, dental x-rays, and cleaning with no copay.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $270 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $375 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Aetna Medicare Value Plus (PPO) plan. Outpatient hospital services have a copay between $0 and $300, observation services have a $275 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $45 copay, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (PPO) plan, with a $85 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value Plus (PPO). Ground Ambulance Services have a $290 copay, while Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value Plus (PPO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, while physician specialist services have a copay between $0 and $30. Mental health and psychiatric services, as well as opioid treatment program services, have a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $55.
Preventive Services See details
The Aetna Medicare Value Plus (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, all with no copay. The plan also covers Kidney Disease Education Services with 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are covered with a maximum benefit of $2000 per year, and Prescription Hearing Aids (all types) are covered with no copay. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams and eyewear have no copay, and eyewear has a combined maximum plan benefit of $300 per year.
Dental Services See details
The Aetna Medicare Value Plus (PPO) plan covers dental services including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Orthodontic services are covered up to a $2,000 annual maximum, and restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with coinsurance between 20% and 50%, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value Plus (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (PPO). Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices have a 20% coinsurance; Diabetic Supplies have a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value Plus (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $325, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (PPO) plan with no copay and no coinsurance, however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value Plus (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (PPO) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $150 every three months, but acupuncture, meal benefits, and several other services are not covered. Other services, including annual wellness exams, screening mammography, gFOBT, and FIT, are covered with no copay.
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