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Aetna Medicare Value Select (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Select (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 Select (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Value Select (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Bronx, Brooklyn, NYC, Queens, Nassau, Westchester. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Select (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 Select (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 Select (HMO), 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 $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 Select (HMO) plan has a $590.00 deductible for prescription drugs. Once you meet your deductible, you'll pay a copay or coinsurance for your medications, depending on the drug tier and pharmacy. For Tier 1 preferred generic drugs, there is no copay at preferred pharmacies or preferred mail order, but there is a $12.00 copay at standard pharmacies or standard mail order. Other tiers have coinsurance, with 24% for standard generic drugs and 25% for preferred brand and non-preferred drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Select (HMO) plan offers a range of benefits with varying cost-sharing. Many services, like primary care visits, preventive services (including an annual physical), and outpatient blood services, have no copay. You'll encounter copays for services like inpatient hospital stays, emergency services, specialist visits, and hearing exams. The plan covers dental, vision, and hearing services. Dental services have a $1,500 annual maximum, and vision includes eye exams and eyewear with no copay. Hearing services include hearing exams and evaluations for hearing aids with no copay.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric, are covered with prior authorization required. For acute inpatient hospital stays, you'll pay a $399 copay for days 1-6, and no copay for days 7-90; for psychiatric inpatient hospital stays, you'll pay a $339 copay for days 1-6, and no copay for days 7-90. Additional days for acute inpatient hospital are covered with no copay, while non-Medicare covered stays and upgrades for acute inpatient hospital are not covered, and additional days and non-Medicare covered stays for inpatient hospital psychiatric are also not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $390, observation services have a $399 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $45, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Select (HMO) plan. This benefit requires prior authorization and has a copay of $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Select (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, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Value Select (HMO) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $300 copay. There is no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value Select (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $30 copay. Physician specialist services have a copay between $10 and $45, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a $45 copay for individual and group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Aetna Medicare Value Select (HMO) plan covers preventive services including an annual physical exam with no copay. Additional preventive services like Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies are covered with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), and several others are not covered.
Hearing Services See details
Hearing services under the Aetna Medicare Value Select (HMO) plan include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, each limited to once per year. Prescription hearing aids are partially covered, with a maximum copay of $1700 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value Select (HMO) plan covers vision services, including eye exams with a copay of $0-$45, and eyewear with no copay. Routine eye exams are covered with no copay for one visit every year.
Dental Services See details
Dental services are covered with a $1,500 annual maximum. 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. However, 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 with prior authorization. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Select (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 Select (HMO) plan, with no copay and a coinsurance between 0% and 20% for Durable Medical Equipment (DME). Prosthetic devices and diabetic therapeutic shoes/inserts have a 20% coinsurance, and medical supplies have a coinsurance between 0% and 20%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. Diagnostic procedures/tests have a copay between $0 and $45, lab services have no copay, diagnostic radiological services have a copay up to $300, therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $45 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Select (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 Select (HMO) plan. However, the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Select (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 Select (HMO) plan does not cover acupuncture, 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, Self-Directed Personal Assistance Services, or Dual Eligible SNPs with Highly Integrated Services. This plan covers over-the-counter (OTC) items with no copay, and a maximum plan benefit coverage amount of $45.00 every three months, and also covers a meal benefit with no copay. Other services such as an annual wellness exam and screening mammography, and gFOBT/FIT, are covered with no copay.
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