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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 Central 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 $11300.00 (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 $11300.00 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. For Tier 1 preferred generics and Tier 2 generics, you pay no copay when using a preferred pharmacy or preferred mail order service for a one, two, or three-month supply. If you choose a standard pharmacy or standard mail order, Tier 1 copays start at $2 and Tier 2 copays start at $12 for a one-month supply. Brand-name and specialty medications under this plan require coinsurance rather than flat copayments. Tier 3 preferred brands carry a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply across all preferred and standard pharmacy and mail order options.
Additional Benefits
The Aetna Medicare Value Plus (PPO) plan offers robust medical coverage featuring no copay or coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a copay of up to $40, while inpatient hospital stays incur a $390 daily copay for the first six days. Emergency care is covered with a $115 copay, which is waived upon admission, and urgent care visits require a $40 copay. This plan also includes essential wellness benefits, offering no copays for routine dental, vision, and hearing exams. Comprehensive dental is covered with a 20% to 50% coinsurance up to a $1,000 annual maximum, alongside allowances for eyewear and prescription hearing aids. Additionally, members can take advantage of a $15 quarterly allowance for over-the-counter health items with no copay.
Inpatient Hospital See details
Aetna Medicare Value Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $390 copayment for days 1 to 6 of acute stays and a $300 copayment for days 1 to 6 of psychiatric stays, with no copayments for days 7 to 90. Non-Medicare-covered stays, acute upgrades, 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 outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $450, observation services cost a $390 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Plus (PPO) with a copay of $70 or $110 and no coinsurance. Prior authorization is required for these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (PPO) covers ambulance services with prior authorization, requiring a $340 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Routine 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 $115 copay (waived if admitted within 24 hours) and urgently needed services with a $40 copay, both with no coinsurance or deductible. Worldwide emergency, urgent, and transportation services are also covered up to a $250,000 maximum with no coinsurance and copays ranging from $115 to $340.
Primary Care See details
Primary Care benefits under the Aetna Medicare Value Plus (PPO) plan feature no copay and no coinsurance for primary care physician services, while specialist visits require a $0 to $40 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, as routine and other chiropractic services are not covered, whereas podiatry services are not covered. Therapy, mental health, and psychiatric services have a $35 to $40 copay and no coinsurance, while telehealth services require a $0 to $40 copay and 20% coinsurance.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (PPO), offering annual physicals, glaucoma screenings, and fitness benefits with no copay and no coinsurance, while kidney disease education requires no copay and a 20% coinsurance. Non-covered services 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 safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Aetna Medicare Value Plus (PPO), featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models 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. Members receive up to $50 annually for routine eye exams and a $150 combined annual maximum for eyewear, with no deductibles required.
Dental Services See details
Dental services are partially covered under the Aetna Medicare Value Plus (PPO) plan, with Medicare-covered dental requiring a $40 copay and no coinsurance, while preventive exams, cleanings, and x-rays are available with no copay and no coinsurance. Comprehensive dental services are covered with no copay and 20% to 50% coinsurance up to a $1,000 annual maximum, but fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (PPO) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay with no coinsurance, while chemotherapy and other Part B drugs have a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Value Plus (PPO) plan 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 equipment, with no copays. Coinsurance ranges from no coinsurance up to 20% depending on the item, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (PPO) with no coinsurance for diagnostic services, no copay for lab services and outpatient X-rays, and a copay of $0 to $50 for diagnostic procedures. Diagnostic radiological services feature a $0 minimum copay, while therapeutic radiological services require a minimum 20% coinsurance, with prior authorization required for both categories of services.
Home Health Services See details
Aetna Medicare Value Plus (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under the Aetna Medicare Value Plus (PPO), but only some services are covered in practice. Specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require copays ranging from $15 to $20.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Value Plus (PPO), featuring no copay and no coinsurance for over-the-counter (OTC) items up to $15 every three months, annual wellness exams, screening mammographies, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered under this plan.
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