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Aetna Medicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (HMO-POS). 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-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Central Upstate NY 1. 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-POS) 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-POS).
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-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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-POS) plan has a $450 deductible for prescription drugs. After meeting the deductible, you will pay a copay or coinsurance for your medications. The plan offers an "Enhanced Alternative" drug benefit type. For preferred generic drugs, you will pay no copay at preferred pharmacies and mail order, and a $12 copay at standard pharmacies. For standard generic drugs, you will pay 22% coinsurance. The plan covers preferred brand drugs with 25% coinsurance and non-preferred drugs with 27% coinsurance.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a variety of benefits with varying cost-sharing. Hospital stays have a copay of $300 for days 1-6, but no copay for days 7-90. Outpatient services have copays ranging from $0 to $350, while emergency services have copays between $45 and $110. This plan includes coverage for primary care with no copay, along with vision, hearing, and dental services, with some cost-sharing requirements. Diagnostic and radiological services have copays that vary from $0-$250, and home health services have no copay. The plan also covers skilled nursing facility services with a copay, and offers a meal benefit with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Value (HMO-POS) plan, with a copay of $300 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric benefits are covered with a copay of $300 for days 1-6 and no copay for days 7-90, while additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $350, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan. Ground and air ambulance services require a $300 copay, but there is no coinsurance, while 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 by the Aetna Medicare Value (HMO-POS) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay; both have no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $300 copay; all three have no coinsurance.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay (routine care not covered), Occupational Therapy Services with a $25 copay, Physician Specialist Services with a copay between $0 and $35, and Mental Health Specialty Services with a $25 copay for individual or group sessions. The plan also covers Other Health Care Professional services with a copay between $0 and $35, Psychiatric Services with a $25 copay for individual or group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services with a $25 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Aetna Medicare Value (HMO-POS) plan. You will have no copay for your annual physical exam, and other preventive services may have a copay. Kidney Disease Education Services have a 20% coinsurance.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Value (HMO-POS) plan, including hearing exams with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay, and prescription hearing aids (all types) have a maximum copay of $1700, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Aetna Medicare Value (HMO-POS) covers vision services, including eye exams with a copay of $0-$25, and eyewear with no copay. Routine eye exams are limited to one per year with no copay, while other eye exam services have no copay and are unlimited. Eyewear has a combined maximum benefit of $180 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, all with no copay.
Dental Services See details
Dental services are covered, with a $1,250 annual maximum. Medicare dental services have a $25 copay, while 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 and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Value (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value (HMO-POS) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has a coinsurance of 0-20%, and diabetic supplies have a coinsurance of 0-20%, while prosthetic devices and diabetic therapeutic shoes/inserts have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $25, Lab Services with no copay, and Diagnostic Radiological Services with a copay up to $250. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (HMO-POS) 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 (HMO-POS) plan. The plan does not cover any Cardiac Rehabilitation Services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Aetna Medicare Value (HMO-POS) covers Other Services, but acupuncture, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan offers a meal benefit with no copay, and also covers services such as annual wellness exams, screening mammography, gFOBT, and FIT with no copay.
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