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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 Cochise, Gila and Santa Cruz 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 $4.60. 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 $5500.00 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 deductible. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at a preferred pharmacy or through the mail. For standard generic drugs, you will pay 24% coinsurance, regardless of the pharmacy. For preferred brand and non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays depending on the length of stay, while outpatient services have a mix of copays and no copays depending on the specific service. Emergency services have copays, and primary care services often have no copay, but specialist visits and mental health services have copays. Preventive services like annual exams and many screenings have no copay, and vision and hearing services also have no copay for exams. Dental services are covered with no copay for many services, and offer a maximum of $2500 per year. The plan also includes coverage for home infusion, dialysis, medical equipment, and home health services with varying cost-sharing, and offers an OTC benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Aetna Medicare Value Plus (HMO-POS) plan. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services with the Aetna Medicare Value Plus (HMO-POS) plan include outpatient hospital services with a copay between $0 and $295, observation services with a $295 copay, ambulatory surgical center 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.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (HMO-POS) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, where ground ambulance services have a $290 copay, and air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay and no coinsurance, and Worldwide Emergency Transportation has a $290 copay and no coinsurance.
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, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a copay from $0 to $40, and Physical Therapy and Speech-Language Pathology Services with a $30 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay from $0 to $55. Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services like Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Wigs for Hair Loss Related to Chemotherapy, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Kidney Disease Education Services have a 20% coinsurance. Some services, such as In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others, are not covered.
Hearing Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a plan-specified amount up to $1,000 per year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum of $200 per year.
Dental Services See details
Dental services include coverage for 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, as well as a $40 copay for Medicare dental services; however, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan offers a maximum of $2500 per year for dental services.
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.
Dialysis Services See details
Dialysis Services are covered by 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 benefits are covered under the Aetna Medicare Value Plus (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0-20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $225, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have a $20 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, though Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan does not specify the copay or coinsurance for the covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO-POS), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. 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 other services including Over-the-Counter (OTC) Items with no copay, up to $50 every three months. However, acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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