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 Metro: Staten Island. 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 $36.00. 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 $590.00 deductible for prescription drugs. After the deductible is met, you will pay for your prescriptions based on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay no copay at preferred pharmacies or preferred mail order, and a $12.00 copay at standard pharmacies and standard mail order. Standard generic, preferred brand, and non-preferred drugs have a 22% or 25% coinsurance depending on the drug tier. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO) plan offers coverage for a wide range of services with varying cost-sharing options. Hospital stays have a copay, while outpatient services have a mix of copays. Emergency, primary care, and preventive services generally have copays, with some services having no copay. This plan provides coverage for hearing and vision services, with copays for hearing exams and prescription hearing aids, and eye exams and eyewear, and dental services with no copay. Additionally, the plan covers home health services, and skilled nursing facility stays with copays. Other benefits include ambulance services, diagnostic and radiological services, and home infusion services, each with specific cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a copay of $395 for days 1-6 and no copay for days 7-90, and require prior authorization. Additional days for inpatient hospital-acute are covered, but non-Medicare covered stays and upgrades for inpatient hospital-acute and psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $395, observation services with a $395 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $45 copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO) plan and 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) plan. Both ground and air ambulance services have a $300 copay, and there is no coinsurance for these services. 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 have a $110 copay, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Services have a $110 copay for Worldwide Emergency and Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation. 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 $10 copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a $45 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health and psychiatric services, as well as opioid treatment program services, are covered with a $45 copay for individual and group sessions. Other health care professionals have a copay between $0 and $45. 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
Preventive services include an annual physical exam with no copay, and other services like Health Education, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit are covered with no copay. 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 have no copay.
Hearing Services See details
Hearing services include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay up to $1700, but prescription hearing aids for the inner ear, outer ear, and over the ear, as well as 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-$45, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $150 per year.
Dental Services See details
Aetna Medicare Value (HMO) covers dental services, including oral exams with no copay, dental x-rays with no copay, and prophylaxis (cleaning) with no copay. Fluoride treatment, orthodontic services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
The Aetna Medicare Value (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Aetna Medicare Value (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 0% to 20% coinsurance and Prosthetics/Medical Supplies, Diabetic Equipment, Diabetic Supplies with a 0% to 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance; however, Durable Medical Equipment for use outside the home is not covered. There is no copay for any of the services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $45, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $395, and Therapeutic Radiological Services have up to 20% coinsurance. Outpatient X-Ray Services have a $45 copay.
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 covered by the Aetna Medicare Value (HMO) plan, but the plan does not specify the cost sharing details for these services. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits 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 does not cover acupuncture, Over-the-Counter (OTC) 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. The plan covers the Meal Benefit with no copay, and "Other 1" and "Other 2" services with no copay.
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