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Aetna Medicare Value Care (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Care (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 Care (HMO-POS) in 2026, please refer to our full plan details page.
Aetna Medicare Value Care (HMO-POS) is a HMO-POS plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Southeastern Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Care (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 Care (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 Care (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $7500.00 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 Care (HMO-POS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for up to a three-month supply when using preferred pharmacies or preferred mail order. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $2 to $6, and Tier 2 copays range from $12 to $36 depending on the supply length. For higher-tier medications, costs transition to coinsurance rather than set copays. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance across all pharmacy and mail-order options. Note that Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The Aetna Medicare Value Care (HMO-POS) plan offers robust medical coverage with no copay for primary care physician visits, annual physicals, and home health services. Specialist visits, urgent care, and Medicare-covered dental care require a $40 copay, while emergency room visits carry a $115 copay. For hospital stays, there is no coinsurance, though inpatient acute care requires a $327 daily copay for the first seven days before transitioning to no copay. Ancillary benefits include no copay for routine eye exams, preventive dental care, annual hearing exams, and diagnostic lab services. Members also benefit from a $275 annual eyewear allowance, a $500 annual hearing aid allowance per ear, and a $50 quarterly over-the-counter allowance. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days.
Inpatient Hospital See details
Aetna Medicare Value Care (HMO-POS) covers inpatient acute hospital stays with no coinsurance, requiring a $327 daily copay for days 1 to 7 and no copay for days 8 and beyond. Inpatient psychiatric care is covered with no coinsurance, requiring a $176 daily copay for days 1 to 9 and no copay for days 10 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Aetna Medicare Value Care (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $325, observation services carry a $325 copay per stay, and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Aetna Medicare Value Care (HMO-POS) covers partial hospitalization services with a copay ranging from no copay to $110 and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Aetna Medicare Value Care (HMO-POS) covers ambulance services with a $300 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport, both requiring prior authorization. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Aetna Medicare Value Care (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $250,000 limit with no coinsurance and copays ranging from $115 to $300.
Primary Care See details
Primary Care benefits under Aetna Medicare Value Care (HMO-POS) include primary care physician visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Most therapy, mental health, and podiatry services range from a $35 to $40 copay with no coinsurance, while telehealth services require a $0 to $40 copay and 20% coinsurance. Chiropractic services are only partially covered, as routine chiropractic care is not covered.
Preventive Services See details
Aetna Medicare Value Care (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for annual physicals, health education, and various screenings, though kidney disease education requires a 20% coinsurance and no copay. Several supplemental services are not covered under this plan, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are covered under the Aetna Medicare Value Care (HMO-POS) plan, featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fittings. Prescription hearing aids are partially covered with no copay or coinsurance up to $500 per ear annually, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Aetna Medicare Value Care (HMO-POS) covers vision services with no deductibles and no coinsurance, featuring a $0 to $40 copay for eye exams and no copay for eyewear. Routine eye exams (one per year) and eyewear—including contacts, frames, lenses, and upgrades—have no copay, with a combined eyewear allowance of $275 annually.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Care (HMO-POS), featuring no copay or coinsurance for preventive care like cleanings and exams, and a $40 copay with no coinsurance for Medicare-covered dental. Comprehensive services have no copay and 20% to 50% coinsurance up to a $1,000 annual maximum, though fluoride, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Aetna Medicare Value Care (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Care (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Aetna Medicare Value Care (HMO-POS) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copays and prior authorization required. Depending on the item, coinsurance ranges from no coinsurance up to 20%, with diabetic therapeutic shoes and prosthetic devices requiring a flat 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Aetna Medicare Value Care (HMO-POS) with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay of up to $5, lab services have no copay, outpatient X-rays require a $35 copay, and therapeutic radiology services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Aetna Medicare Value Care (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Aetna Medicare Value Care (HMO-POS) with no copay and no coinsurance. Although some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Aetna Medicare Value Care (HMO-POS) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a three-day prior inpatient hospital stay is not required for admission, additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered by Aetna Medicare Value Care (HMO-POS) with no copay and no coinsurance, including chronic illness meals, annual wellness exams, screening mammographies, additional gFOBT and FIT screenings, and a $50 quarterly over-the-counter allowance. Acupuncture is not covered under this benefit.
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