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Aetna Medicare Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Plus (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 Plus (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 Plus (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 $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 $2500.00 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 Plus (HMO-POS) plan has an Enhanced Alternative drug benefit. The plan includes a deductible of $590. Once the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies or through the mail, and a $12 copay at standard pharmacies. Standard generic drugs, preferred brand drugs, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have copays, with different amounts depending on the type of care and the length of stay. Outpatient services have copays, and emergency services have copays as well. This plan also covers primary care, preventive, hearing, vision, and dental services with some services having no copay. Additionally, the plan includes coverage for medical equipment, home health, and other services with varying coinsurance and copays.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $100 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $50, Observation Services with a $100 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay. This plan also includes an enhanced benefit of three waived deductible pints for Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $275 copay, and air ambulance services with 20% 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 by the Aetna Medicare Value Plus (HMO-POS) plan. Emergency Services has a $140 copay, and Urgently Needed Services has a $20 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The Aetna Medicare Value Plus (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy with no coinsurance and no copay. It also covers physician specialist services with a copay between $0 and $20, and mental health specialty services with a $40 copay for both individual and group sessions. Additionally, the plan covers other health care professionals with a copay between $0 and $20, psychiatric services with a $40 copay for both individual and group sessions, physical therapy and speech-language pathology services with no copay and no coinsurance, and opioid treatment program services with a $40 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $40.
Preventive Services See details
Preventive services include an annual physical exam with no copay, while additional preventive services may have a copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services are covered, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $1250.00 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers vision services, including eye exams and eyewear. There is no copay for eye exams, routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum plan benefit coverage of $300 per year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $20 copay, and other services, up to a maximum of $2,500 per year. 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 are covered with 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 with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Value Plus (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20% and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance. Medical supplies have a coinsurance between 0% and 20%. Diabetic equipment has a coinsurance and copay, with Diabetic Supplies having a coinsurance between 0% and 20% and Diabetic Therapeutic Shoes/Inserts having no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $115, Outpatient X-Ray Services have no copay, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value Plus (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 technically covered by the Aetna Medicare Value Plus (HMO-POS) plan, but the plan does not cover the sub-services of 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. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. You will have a $20 copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers over-the-counter items with no copay and a maximum benefit coverage amount of $75.00 every three months, but acupuncture, meal benefits, and other services are not covered. The plan also covers other services such as annual wellness exams and screening mammography, as well as gFOBT and FIT, with no copay.
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