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Aetna Medicare Prime Value Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Prime 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 Prime Value Plus (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Prime Value Plus (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Maricopa County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Prime 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 Prime 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 Prime Value Plus (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.50. 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 $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 $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 Prime Value Plus (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and through the mail. For standard generic drugs, you'll pay 24% coinsurance. Preferred brand drugs and non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Aetna Medicare Prime Value Plus (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with varying copays depending on the length of stay and type of care. Outpatient services have copays that vary by service. Additionally, this plan covers emergency services, primary care, preventive services, hearing, vision, dental, and home health services, with varying copays and coinsurance amounts depending on the service. This plan also provides coverage for ambulance services, with a copay for ground ambulance and coinsurance for air ambulance, as well as partial hospitalization. It also covers medical equipment, home infusion, dialysis, and diagnostic services. The plan includes additional benefits such as OTC items and offers coverage for skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For acute care, there is a $195 copay for days 1-7, and no copay for days 8-90. Psychiatric care has a $370 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $175, observation services with a $195 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 by the Aetna Medicare Prime Value Plus (HMO-POS) plan, and requires prior authorization. The plan has a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan. Ground Ambulance Services have a copay of $265, while Air Ambulance Services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan. Emergency Services has a $140 copay, Urgently Needed Services has a $50 copay, and Worldwide Emergency Services has varying copays depending on the service: $140 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $265 for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $20 copay, and specialist services with a $20 copay. Mental health and psychiatric services, as well as opioid treatment programs, require prior authorization and have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50. Podiatry services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other preventive services with no copay for glaucoma screening, 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 include health education, additional sessions of smoking and tobacco cessation counseling, and fitness benefits with no copay.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit coverage of $1000 per ear every year, but specific types of prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear coverage. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and have a combined maximum benefit of $250 per year.
Dental Services See details
Dental services under the Aetna Medicare Prime Value Plus (HMO-POS) plan include Medicare dental services with a $20 copay, 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, prosthodontics, fixed, and oral and maxillofacial surgery with no copay. The plan does not cover maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with 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 Prime Value Plus (HMO-POS) plan, requiring prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a coinsurance of 0% to 20%. Prosthetics/medical supplies are covered with no copay and coinsurance for Medicare-covered devices and supplies. Diabetic equipment is covered, with no copay for therapeutic shoes or inserts and a coinsurance of 0% to 20% for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $5, lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Prime 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 not covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Prime Value Plus (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Aetna Medicare Prime Value Plus (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, up to a maximum of $50 every three months. Other services such as Acupuncture, Meal Benefit, and several additional services are not covered.
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