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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 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 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 $0.20. 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 $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 Plus (HMO-POS) plan has an "Enhanced Alternative" drug benefit. This plan has a deductible of $590.00. In the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order pharmacies, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage with a variety of benefits. You'll find no copays for primary care, many outpatient services, preventive services, vision, dental, and home health services. Additionally, the plan includes coverage for inpatient and outpatient services, with varying copays depending on the service. This plan also covers emergency services, ambulance services, and mental health services, with copays ranging from $0-$370. Other benefits include hearing services, home infusion, dialysis, and medical equipment, which may involve copays or coinsurance. The plan also offers other services, such as OTC items, with no copay up to $75 every three months.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $100 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5, and no copay for days 6-90; however, additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $325, observation services have a $100 copay, ambulatory surgical center services have no copay, and individual and group outpatient substance abuse sessions have a $30 copay. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan. This benefit requires prior authorization and has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Value Plus (HMO-POS) plan. Ground ambulance services have a $325 copay, and air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under the Aetna Medicare Value Plus (HMO-POS) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $30 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered, with copays of $140, $140, and $325, respectively, and no coinsurance.
Primary Care See details
The Aetna Medicare Value Plus (HMO-POS) plan covers primary care, physician specialist services, and other health care professional services with no copay, while chiropractic services, occupational therapy, and physical/speech therapy have a $10 copay. Mental health and psychiatric individual and group sessions have a $30 copay, and telehealth benefits have a 20% coinsurance and a copay ranging from $0-$30. Opioid treatment program services have a $30 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. This plan also covers wigs for hair loss related to chemotherapy and additional sessions of smoking and tobacco cessation counseling with no copay, as well as fitness benefits, but some services such as in-home safety assessments, personal emergency response systems, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams, routine hearing exams (1 per year, with no copay), and fitting/evaluation for hearing aids (1 per year, with no copay). Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with a $0 copay for all services. Routine eye exams are limited to one per year, and eyewear has a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are covered, with a $30 copay for Medicare dental services. Other services like oral exams, dental x-rays, and other diagnostic and preventative services have no copay. There is a $2,500 maximum benefit per year. Orthodontic services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 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, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by the Aetna Medicare Value Plus (HMO-POS) plan. Durable medical equipment has a coinsurance of 0-20%, while medical supplies have a coinsurance of 0-20%. Diabetic therapeutic shoes/inserts have no copay, while diabetic supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with no copay, Lab Services with no copay, Diagnostic Radiological Services with a copay of at most $75, and Therapeutic Radiological Services with coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
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. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation, Medicare-covered Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered. The plan has a copay, but the specific amount is not specified in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $75 every three months. Other services like acupuncture, meal benefits, and several others are not covered.
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