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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 Northeastern and Youngstown Area. 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 $6900.00 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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a wide range of benefits with varying costs. Hospital stays have a $325 copay for the first four days, but no copay for the rest of the stay, and outpatient services have copays between $0 and $300. Emergency services have a $95 copay, and you'll find no copays for primary care visits, routine hearing exams, and eyewear. Preventive services, including an annual physical exam, are covered with no copay, and the plan also includes dental, vision, and hearing benefits. You'll have a $40 copay for hearing exams, and dental services are covered with a $30 copay. The plan also covers home health services with no copay, and skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-4, and no copay for days 5-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $325 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days for Inpatient Hospital Psychiatric and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value (HMO-POS) plan, including outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $40, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan and requires prior authorization. You will have a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan, with a $235 copay for both ground and air ambulance services and 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-POS) plan. Emergency Services has a $95 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $95 copay, while Worldwide Emergency Transportation has a $235 copay.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay. Specialist and other health care professional services have a copay between $0 and $30, while physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Mental health and psychiatric services, and opioid treatment program services, require prior authorization and have a $40 copay for individual and group sessions.
Preventive Services See details
The Aetna Medicare Value (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, like health education, are covered with no copay, while kidney disease education services have a 20% coinsurance. Other services like in-home safety assessments, personal emergency response systems, and more are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $40 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay for one visit per year. Prescription hearing aids (all types) are covered with no copay for two visits per year, with a maximum benefit of $2000 per year.
Vision Services See details
Aetna Medicare Value (HMO-POS) covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams and other eye exam services have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, up to a combined maximum of $370 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $30 copay, and other dental services with a $2,200 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered, and orthodontics are only covered under diagnostic and preventive dental.
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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Value (HMO-POS) plan, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment, which includes Diabetic Supplies with a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Under the Aetna Medicare Value (HMO-POS) plan, diagnostic and radiological services are covered. Diagnostic Procedures/Tests have a copay between $0 and $45, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $150, while Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no 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, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value (HMO-POS) plan, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services. While the plan does cover some cardiac rehabilitation services, specific details regarding copays are not provided.
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. Additional days beyond Medicare-covered, 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, up to a maximum of $165 every three months. Other services like acupuncture, meal benefits, and several other services are not covered.
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