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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 Pima 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 $9.90. 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 $2700.00 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 for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay no copay at preferred pharmacies and $12 at standard pharmacies. For other tiers, you will pay coinsurance of 24% or 25% depending on the drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for many services such as primary care visits, preventive services, vision exams and eyewear, dental services, home health services, and some outpatient services. The plan also offers additional benefits like hearing aids, outpatient substance abuse services, and over-the-counter items. However, the plan does have copays for some services, such as inpatient hospital stays, ambulance services, and specialist visits. There are also coinsurances for services like air ambulance, dialysis, and home infusion. Overall, this plan provides a wide range of services with varying costs, so it's important to review the specific details to understand your potential out-of-pocket expenses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Aetna Medicare Value Plus (HMO-POS) plan, with a copay of $195 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a copay of $370 for days 1-5 and no copay for days 6-90; Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Outpatient Hospital Services have a copay between $0 and $175, Observation Services have a $195 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including both individual and group sessions, have a copay of $40. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan, and requires prior authorization. For this benefit, you will have a $55 copay.
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 $290 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered, with a $140 copay and no coinsurance. Urgently Needed Services are covered, with a $50 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are also covered, with copays of $140 or $290, and no coinsurance.
Primary Care See details
Aetna Medicare Value Plus (HMO-POS) covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (routine care is not covered), Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $25 copay, Mental Health Specialty Services with a $40 copay for individual and group sessions, Other Health Care Professional services with a copay between $0 and $25, Psychiatric Services with a $40 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $25 copay, and Additional Telehealth Benefits with a 20% coinsurance and a copay between $0 and $50. Opioid Treatment Program Services are covered with a $40 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, and additional preventive services, which include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Wigs for Hair Loss Related to Chemotherapy, with no copay. Kidney Disease Education Services have a 20% coinsurance, while Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing exams are covered with no copay. Routine hearing exams and fitting/evaluation for hearing aids are also covered with no copay, with a limit of one visit per year. Prescription hearing aids are covered, with a maximum benefit of $1000 per year.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have no copay, and include routine eye exams, and other eye exam services. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum benefit of $250 per 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 and prior authorization, and there is a $2,500 maximum plan 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs can range from 0% to 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, and diabetic equipment, is covered under the Aetna Medicare Value Plus (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a coinsurance between 0% and 20%. Diabetic supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and outpatient X-Ray services, are covered with a copay of up to $5 for diagnostic procedures/tests, no copay for lab services and outpatient X-Ray services, and a copay of up to $175 for diagnostic radiological services. Therapeutic radiological services are covered with a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Value Plus (HMO-POS) 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 under the Aetna Medicare Value Plus (HMO-POS) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Plus (HMO-POS) with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
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 $50 every three months. The plan does not cover 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, or Self-Directed Personal Assistance Services. Other services, including annual wellness exams and screening mammography, and gFOBT/FIT, are covered with no copay.
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