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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 Western New York. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 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 $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will pay a $5 copay at a preferred pharmacy for preferred generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan may have a reduced premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. You'll find that many services have no copay, including primary care visits, routine eye exams, and preventive services like annual physicals. However, services like inpatient hospital stays have a $300 copay for the initial days, and emergency services have a $110 copay. The plan also covers outpatient services, hearing, vision, and dental, often with no copay or a small copay. Additional benefits include coverage for home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. Some services, like dialysis and durable medical equipment, have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $35 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value (HMO-POS) plan, but requires prior authorization. You will pay a $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value (HMO-POS). 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 by the Aetna Medicare Value (HMO-POS) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, while Worldwide Emergency Transportation has a $300 copay.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay for routine care. Occupational therapy services have a $35 copay, while physician specialist services have a copay between $0 and $35. Mental health specialty services, psychiatric services, and opioid treatment services have a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay. Other health care professional services have a copay between $0 and $35, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services with varying copays. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Value (HMO-POS) plan cover hearing exams for a $35 copay, with routine hearing exams and fitting/evaluation for hearing aids covered with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700, 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
The Aetna Medicare Value (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $35, routine eye exams with no copay, and other eye exam services with no copay. Eyewear is covered with no copay, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, including 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, all with no copay. Medicare dental services have a $35 copay and require prior authorization, and other services have a $1,750 annual maximum. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Value (HMO-POS) 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/Medical Supplies have a coinsurance, and the plan covers Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies. Diabetic Equipment is covered, 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 Aetna Medicare Value (HMO-POS), with a copay for Diagnostic Procedures/Tests ranging from $0 to $35, and Lab Services with no copay. Diagnostic Radiological Services have a copay of at most $200, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $35 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. Although the plan covers Cardiac Rehabilitation Services, none of the sub-services are covered.
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, and for days 21-100, the copay is $214. The plan does not cover additional days beyond Medicare-covered for SNF or non-Medicare-covered stays for SNF.
Other Services See details
The Aetna Medicare Value (HMO-POS) plan covers acupuncture with a $35 copay for up to 12 treatments per year, a meal benefit with no copay, and other services with no copay. However, over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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