A non-government entity
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 Washoe County. 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 $4200.00 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:
Sign up for Aetna Medicare Value Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Aetna Medicare Value Plus (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose standard pharmacies or standard mail-order services, copays range from $2 to $6 for Tier 1 and $12 to $36 for Tier 2 depending on the supply length. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 22% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty drugs restricted to a one-month fill.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers robust medical coverage with no copay for primary care physician visits, while specialist visits and mental health services require a $40 copay. For hospital care, inpatient acute stays require a $300 copay for days one through seven, and outpatient hospital services range from no copay to a $300 copay. Emergency room visits feature a $150 copay, which is waived upon admission, and urgent care visits require a $30 copay. In addition to core medical care, the plan provides preventive benefits with no copays for annual physicals, routine eye exams, and preventive dental cleanings. Members also benefit from a $125 annual eyewear allowance, up to $1,000 per ear yearly for prescription hearing aids, and a $30 quarterly allowance for over-the-counter items. However, certain services like cardiac rehabilitation, acupuncture, and routine transportation are not covered.
Inpatient Hospital See details
Inpatient hospital services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, requiring a $300 copay for days 1-7 of acute stays (no copay for days 8 and beyond) and a $370 copay for days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required for these benefits, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, featuring no copays for ambulatory surgical center and blood services, and copays ranging from $0 to $300 for outpatient hospital and observation services. Outpatient substance abuse individual and group sessions require a $40 copay, and prior authorization is required for several of these services.
Partial Hospitalization See details
The Aetna Medicare Value Plus (HMO) plan covers partial hospitalization services with a copay of either $55.00 or $180.00 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are offered by Aetna Medicare Value Plus (HMO), featuring a $295 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance, with prior authorization required. Although transportation is technically listed as covered, only some services are covered in practice, as transportation to plan-approved locations and any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Value Plus (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no coinsurance and copays ranging from $150 to $295, up to a $250,000 maximum limit.
Primary Care See details
Primary care benefits under Aetna Medicare Value Plus (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist visits, physical therapy, occupational therapy, and mental health services require a $40 copay and no coinsurance. Telehealth services are covered with a 20% coinsurance and a $0 to $40 copay, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Aetna Medicare Value Plus (HMO), featuring no copay and no coinsurance for annual physicals, fitness benefits, and various screenings, while kidney disease education requires a 20% coinsurance and no copay. Multiple supplemental benefits are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Aetna Medicare Value Plus (HMO) offers hearing services with no copay, no coinsurance, and no deductible for covered exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 maximum per ear yearly, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (HMO) with no copay and no coinsurance for both eye exams and eyewear. The plan includes one routine eye exam annually and provides up to a $125 yearly allowance for eyewear, including eyeglasses, contact lenses, frames, and upgrades.
Dental Services See details
Aetna Medicare Value Plus (HMO) offers partially covered dental services, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive services like exams and cleanings. Comprehensive benefits like restorative care and endodontics have no copay and 20% to 50% coinsurance up to a $500 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive services 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. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while other Part B chemotherapy, radiation, and clinical drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Aetna Medicare Value Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers medical equipment—including durable medical equipment, prosthetics, and diabetic supplies—with no copays for any covered items. Coinsurance for these services ranges from no coinsurance to 20%, and prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Plus (HMO), though prior authorization is required. Diagnostic tests, lab services, and diagnostic radiology feature no copay and no coinsurance, while outpatient x-rays have no copay and therapeutic radiology requires a copay alongside a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (HMO) covers Home Health Services with no copay and no coinsurance, although 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 related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Aetna Medicare Value Plus (HMO) partially covers other services with no copay and no coinsurance, including an annual wellness exam, additional colorectal screenings, and up to $30 every three months for over-the-counter items. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved