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Aetna Medicare Value Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO) is a HMO 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 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $9.50. 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 $615.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling your prescription through a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail order, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply. For higher-tier prescription drugs, cost-sharing is structured as coinsurance across all pharmacy types. You will pay a 22% coinsurance for Tier 3 preferred brand drugs, and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs also require a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers robust core medical coverage, featuring no copay and no coinsurance for primary care visits, while specialist visits require a $35 copay. Inpatient hospital stays are covered with no coinsurance, requiring a $150 daily copay for the first six days of acute stays, and emergency room visits have a $150 copay. Outpatient services are also highly accessible, with copays ranging from no copay up to $150 and no coinsurance. This plan also includes valuable supplemental benefits, such as routine hearing and vision exams with no copay or coinsurance, alongside annual allowances for eyewear and prescription hearing aids. Preventive dental care features no copay, while comprehensive dental services are covered with a 20% to 50% coinsurance up to a $1,250 yearly limit. Additionally, skilled nursing facility stays require no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital care is partially covered by Aetna Medicare Value Plus (HMO) with no coinsurance, featuring a $150 daily copay for days 1 through 6 of acute stays and a $370 daily copay for days 1 through 5 of psychiatric stays, followed by no copay for remaining stay days. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric stay days are not covered.
Outpatient Services See details
Aetna Medicare Value Plus (HMO) outpatient services are covered with no coinsurance, featuring a copay ranging from no copay to $150 for outpatient hospital services and a $75 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $35 copay, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Aetna Medicare Value Plus (HMO) with a copayment of either $55.00 or $180.00 and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services are not covered by this plan, including trips to plan-approved or any other health-related locations.
Emergency Services See details
Emergency services are covered by Aetna Medicare Value Plus (HMO) with a $150 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services have a $20 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $150 to $275.
Primary Care See details
Aetna Medicare Value Plus (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapies, and mental health services require a $35 copay and no coinsurance. Telehealth benefits are available with a $0 to $35 copay and 20% coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (HMO) with no copay and no coinsurance for most benefits—such as annual physicals, fitness benefits, and glaucoma screenings—though kidney disease education requires a 20% coinsurance and no copay. Several sub-services are not covered under this plan, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, and alternative therapies.
Hearing Services See details
Aetna Medicare Value Plus (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to $1,000 per ear annually, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (HMO) with no copays, no coinsurance, and no deductibles for both eye exams and eyewear. Covered benefits include one routine eye exam per year, follow-up diabetic eye exams, and up to a $150 annual maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by Aetna Medicare Value Plus (HMO), offering preventive care like cleanings and exams with no copay and no coinsurance, and Medicare-covered dental with a $35 copay and no coinsurance. Comprehensive services are available with no copay and 20% to 50% coinsurance up to a $1,250 yearly limit, though fluoride, implants, orthodontics, other diagnostic services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (HMO) with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Aetna Medicare Value Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by Aetna Medicare Value Plus (HMO) with no copays for durable medical equipment, prosthetics, and diabetic therapeutic shoes, though prior authorization is required. Depending on the item, coinsurance ranges from no coinsurance up to 20% for durable medical equipment, medical supplies, prosthetics, and diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Plus (HMO), with no copay or coinsurance for diagnostic tests, lab work, and diagnostic radiology. Outpatient X-rays have no copay but require coinsurance, while therapeutic radiological services are subject to a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Aetna Medicare Value Plus (HMO) plan, as all key sub-services—including intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO) partially covers Other Services, offering no copay and no coinsurance for over-the-counter items up to $35 every three months, an annual wellness exam and screening mammography, and additional gFOBT and FIT screenings. Acupuncture and meal benefits are not covered.
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