A non-government entity
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 Nassau and Suffolk 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 $82.00. 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 $590.00 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 $590 deductible for prescription drugs. After the deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you have no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic and preferred brand drugs, you will pay 24% and 25% coinsurance, respectively. Non-preferred drugs also have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO) plan offers a wide range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, but some days have no copay. Outpatient services and primary care visits have copays ranging from $0 to $45, and there are no copays for many preventive services, including an annual physical. The plan also covers emergency services, hearing and vision exams, and dental services, all with copays. Additionally, it includes services like home health, skilled nursing, and home infusion, often with no copay or a coinsurance. However, some services like transportation to health-related locations, routine chiropractic care, and podiatry services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $395 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $339 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered by the Aetna Medicare Value (HMO) plan. Outpatient hospital services have a copay between $0 and $395, observation services have a $395 copay, individual and group outpatient substance abuse sessions have a $40 copay, and ambulatory surgical center and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO) plan, with a $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO) plan. Ground and air ambulance services each have a $300 copay, and there is no 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 (HMO) plan. Emergency Services and Worldwide Emergency Coverage each have a $110 copay, while Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Value (HMO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. The plan also covers physician specialist services with a copay between $0 and $45, and physical therapy and speech-language pathology services with a $40 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $45. Mental health and psychiatric services are covered with a $40 copay for individual or group sessions, and opioid treatment program services are covered with a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional services, including health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, and other preventive services, with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing exams are covered with a $45 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids are partially covered, with a maximum copay of $1700 for all types, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and 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 to $45, and there is no coinsurance. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay or coinsurance.
Dental Services See details
Dental Services are covered by the Aetna Medicare Value (HMO) plan. Medicare Dental Services have a $45 copay and other dental services include oral exams, dental x-rays, and prophylaxis (cleaning) with no copay, although fluoride treatment, orthodontic services, and several other dental services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value (HMO) plan, 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 this benefit.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (HMO) plan, but require prior authorization. There is a 20% coinsurance for this service.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Value (HMO) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a coinsurance, and Diabetic Supplies have a coinsurance of 0% to 20%, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $45, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a copay of $45.
Home Health Services See details
Home Health Services are covered by 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 technically covered, but 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, and Additional Cardiac Rehabilitation Services. The plan has 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 the Aetna Medicare Value (HMO) plan. 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
Other Services offered by the Aetna Medicare Value (HMO) plan include a meal benefit with no copay, and annual wellness exams, screening mammography, gFOBT, and FIT tests with no copay. 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.
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