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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 Northern Nevada. 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. Additionally, this plan comes with a Part B Premium reduction of $12.00. You must continue to pay paying your reduced 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 $3400.00 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 $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and a $12 copay at standard pharmacies. For standard generic drugs, you'll pay 24% coinsurance at all pharmacies. Preferred brand and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency and preventive services, such as an annual physical, have no copay, while services like outpatient blood work, hearing exams, and eyewear also have no copay. The plan also provides coverage for home health services with no copay and covers dental services with no copay for many services. This plan includes coverage for ambulance services, with a copay for ground ambulance and coinsurance for air ambulance. Other benefits include coverage for partial hospitalization, primary care, vision services, and medical equipment, each with specific cost-sharing arrangements. The plan does not cover certain services like cardiac rehabilitation, and has a maximum benefit for dental services.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $100 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll pay a $370 copay for days 1-5, and no copay for days 6-90. Additional Days and Upgrades for Inpatient Hospital-Acute, as well as 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 copays ranging from $0 to $325, and observation services with a $100 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (HMO-POS) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (HMO-POS) plan. Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Aetna Medicare Value (HMO-POS), with a $140 copay and no coinsurance. Urgently Needed Services have a $30 copay and no coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and no coinsurance, and Worldwide Emergency Transportation has a $325 copay with no coinsurance.
Primary Care See details
The Aetna Medicare Value (HMO-POS) plan covers Primary Care services with no copay for Primary Care Physician Services, a $10 copay for Chiropractic Services, and a $10 copay for Occupational Therapy Services. Physician Specialist Services, Additional Telehealth Benefits, and Other Health Care Professional services have copays ranging from $0 to $35. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $15 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $10 copay, and Additional Telehealth Benefits have a 20% coinsurance. 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. Additional preventive services include coverage for health education, wigs for hair loss related to chemotherapy, additional sessions for smoking cessation, and fitness benefits, all with no copay. Kidney disease education services have a 20% coinsurance, while 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 exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered up to a plan-specified amount of $1250.00 per year, while inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered under the Aetna Medicare Value (HMO-POS) plan. Eye exams and eyewear have no copay, and the plan provides a combined maximum of $275.00 per year for eyewear.
Dental Services See details
Dental services include coverage for 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 with no copay; however, there is a $30 copay for Medicare dental services, and maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Value (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a 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. 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 with a coinsurance between 0% and 20%. Prosthetics and medical supplies have a coinsurance, and diabetic equipment is covered with a coinsurance between 0% and 20%, and also has a copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a coinsurance of at least 20%.
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. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and 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, with a $0 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Aetna Medicare Value (HMO-POS) plan does not cover acupuncture, over-the-counter items, meal benefits, 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. Other 1 and Other 2 services are covered with no copay.
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