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Aetna Medicare Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Westchester and Rockland 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 (HMO) 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 (HMO).
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 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 $450.00 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 Maximum Out-Of-Pocket cost of $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 (HMO) plan has a $450 deductible for prescription drugs. After you meet your deductible, you'll pay either a copay or coinsurance depending on the drug tier and where you purchase the drug. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy, but you will pay a 22% coinsurance for standard generic drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you will pay $49 per month for Part D.
Additional Benefits
The Aetna Medicare Value (HMO) plan offers comprehensive coverage with a focus on outpatient services and preventive care. You'll find $0 copays for many services including routine eye exams, preventive services such as an annual physical, and many dental services, along with no copays for home health services. The plan also offers coverage for inpatient hospital stays, emergency services, and hearing and vision services, but be aware of copays and coinsurance that may apply to specific services like ambulance, specialist visits, and durable medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Value (HMO) plan. For Inpatient Hospital-Acute, you will pay a $375 copay for days 1-6, and no copay for days 7-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has a $339 copay for days 1-6, and no copay for days 7-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value (HMO) plan, including outpatient hospital services with a copay between $0 and $395, observation services with a $375 copay, ambulatory surgical center (ASC) services with no copay, and outpatient substance abuse services with a $40 copay for both individual and group sessions. Outpatient blood services are also covered, with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO) plan, requiring prior authorization with a $60 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO) plan. Ground and air ambulance services have a $300 copay, but there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services with the Aetna Medicare Value (HMO) plan include a $110 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have copays of $110, $110, and $300 respectively. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value (HMO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $15 copay, while occupational therapy services have a $35 copay. Physician specialist services have a copay between $0 and $35. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional services like health education, wig for hair loss related to chemotherapy, nutritional/dietary benefit, additional sessions of smoking and tobacco cessation counseling, fitness benefit, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are covered with no copay. Kidney disease education services have a 20% coinsurance. Other services like in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay for one visit per year. Prescription hearing aids have a maximum copay of $1700 for "all types" of aids for two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$35, while routine eye exams have a copay of $0, and other eye exam services have a copay of $0. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, has a $0 copay, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, fixed, and oral and maxillofacial surgery with no copay. Orthodontic services are covered under Diagnostic and Preventive Dental, with a maximum benefit of $750 per year, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Aetna Medicare Value (HMO), including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis services are covered under the Aetna Medicare Value (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Aetna Medicare Value (HMO) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20% and requiring authorization. Prosthetic devices and diabetic therapeutic shoes/inserts are covered with a 20% coinsurance, while medical supplies and diabetic supplies have a coinsurance between 0% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, and lab services, with a minimum copay of $0 and a maximum copay of $35 for diagnostic procedures/tests and no copay for lab services. Radiological services are covered with a copay of up to $250 for diagnostic services, a coinsurance of at least 20% for therapeutic services, and a $35 copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Value (HMO) plan, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value (HMO). There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value (HMO) plan's Other Services benefit covers meal benefits and other services such as annual wellness exams and screening mammography, as well as gFOBT and FIT, all with no copay, but does not cover acupuncture, over-the-counter items, or other listed services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services.
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