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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 Southern Maine. This plan received an overall rating of 4.5 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 $250.00 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 $6350.00 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 $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, you will pay a $10 copay at preferred pharmacies and $12 at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance, and for preferred brand drugs, you will pay 26% coinsurance. The plan also covers non-preferred drugs with 30% coinsurance.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a variety of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays ranging from $0 to $325. Emergency services have a $125 copay, and primary care visits have no copay. The plan also includes coverage for preventive services, vision, dental, and hearing services with copays that vary. Additionally, the plan covers home health, home infusion, skilled nursing facility, and dialysis services with varying copays and coinsurance. The plan offers an OTC benefit and meal benefits, but does not cover cardiac rehabilitation or certain other services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, there is a $360 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, there is a $275 copay for days 1-7, and no copay for days 8-90. Additional days 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 include coverage for all outpatient hospital services with a copay between $0 and $325, observation services with a $275 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan, but requires prior authorization. You will have a copay of $85 for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Aetna Medicare Value (HMO-POS), including ground and air ambulance services. Ground ambulance services have a $290 copay, while air ambulance services have a 20% coinsurance; however, transportation services to health-related locations 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 and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $290 copay; all services have no coinsurance.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. The plan also covers physician specialist services with a copay between $0 and $40, and physical therapy and speech-language pathology services with a $40 copay. Mental health and psychiatric services, opioid treatment program services, and other health care professional services have varying copays, while Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the Aetna Medicare Value (HMO-POS) plan. Annual physical exams have no copay, while the plan also covers additional preventive services, including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all of which have no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services have a 20% coinsurance. Other Preventive Services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all of which have no copay.
Hearing Services See details
Hearing services are covered by the Aetna Medicare Value (HMO-POS) plan, including hearing exams with a $40 copay, and routine hearing exams with no copay. Prescription hearing aids (all types) are covered with a copay up to $1700, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$40, and eyewear with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered with no copay, and other eye exam services are also covered with no copay. There is a combined maximum plan benefit coverage of $285 for eyewear every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay, and other dental services with a $1,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatments, 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 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 also covered, with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Value (HMO-POS), including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Value (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $175, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $10 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. 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare coverage, and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay and a maximum benefit of $75 every three months; it also covers a Meal Benefit with no copay, and other services with no copay. Acupuncture and several other services are not covered.
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