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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 Pinal County. 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 $5.30. 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 $3900.00 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 a $590.00 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay at preferred 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 Part D drugs. If you qualify for the low-income subsidy (LIS), you will pay $5.30 for Part D drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services and many preventive services have no copay. The plan also covers services like emergency care, primary care, hearing, vision, and dental, often with no or low copays. This plan provides coverage for ambulance services, with copays or coinsurance depending on the type of transport. Additional benefits include home health services, and skilled nursing facility care. Other services like home infusion, dialysis, medical equipment, and diagnostic services are also covered, but may involve copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $195 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a $370 copay for days 1-5, and no copay for days 6-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient Hospital Services have a copay between $0 and $225, Observation Services have a $195 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Ground ambulance services have a copay of $310, and air ambulance services have 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Worldwide Emergency Transportation has a $310 copay, and Urgently Needed Services has a $50 copay; there is no coinsurance for any of these services.
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 services with a $25 copay. The plan also covers physician specialist services with a copay between $10 and $25, and mental health and psychiatric services with a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Opioid treatment program services have a $40 copay. Podiatry services are 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 Welcome Visit. Kidney Disease Education Services have a 20% coinsurance. Additional preventive services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies have a $0 copay.
Hearing Services See details
Aetna Medicare Value Plus (HMO-POS) covers hearing exams and fitting/evaluation for hearing aids with no copay, and covers prescription hearing aids (all types) with no copay. The plan does not cover prescription hearing aids for the inner, outer, or over the ear, or OTC hearing aids.
Vision Services See details
Aetna Medicare Value Plus (HMO-POS) covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $200.00 every year.
Dental Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers dental services, including 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. Medicare Dental Services require a $25 copay. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. This plan requires prior authorization and has a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 0% to 20% coinsurance and no copay, though durable medical equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have 0% to 20% coinsurance with no copay. Diabetic equipment is covered, and diabetic supplies have 0% to 20% coinsurance and diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $5, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $225, while Therapeutic Radiological Services have 20% coinsurance. 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. 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 plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. The copay for these services is not specified.
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, there is no copay, while days 21-100 have a $214 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and "Other 1" and "Other 2" services with no copay, but acupuncture, 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 are not covered. OTC items have a maximum benefit coverage amount of $50 every three months.
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