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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 Southeastern Pennsylvania. This plan received an overall rating of 4.5 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 $29.00. 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 $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 Plus (HMO-POS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you pay no copay at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic, preferred brand, and non-preferred drugs, you pay 24% or 25% coinsurance, depending on the drug tier. 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 Value Plus (HMO-POS) plan provides comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, but outpatient services, including many diagnostic tests and lab services, have no copay. Emergency services and ambulance services are covered with copays and coinsurance, and the plan also covers a range of other services, including home health and skilled nursing facilities, with varying cost-sharing. This plan includes coverage for primary care, specialist visits, and mental health services with copays. Vision and dental services are included, offering coverage for eye exams, eyewear, and a range of dental procedures. The plan also offers home infusion, dialysis, and medical equipment benefits.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute, with a $300 copay for days 1-7 and no copay for days 8-90, and Inpatient Hospital Psychiatric, with a $176 copay for days 1-9 and no copay for days 10-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. For Outpatient Hospital Services, you may have a copay ranging from $0 to $300. For Observation Services, there is a $300 copay per stay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including both individual and group sessions, have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value Plus (HMO-POS) plan, with a $0 copay. 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 $245 copay, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, with a $110 copay, and no coinsurance. Urgently Needed Services have a $45 copay, and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered with copays of $110, $110, and $245, respectively, 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 $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Mental health and psychiatric services also have a $35 copay for individual and group sessions, podiatry services have a $30 copay, and other health care professional services have a copay between $0 and $35. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45, and Opioid Treatment Program Services have a $35 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered, and some services have a copay as described in the details. Kidney Disease Education Services have a 20% coinsurance. Other preventive services are also covered, with the specific services of Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit having no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a maximum benefit of $500 per year, but hearing aids for the inner ear, outer ear, and over-the-ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered with no copay, but have a combined maximum benefit of $350 every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, and other dental services, with a maximum benefit of $1750 per year. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery all have no copay. 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. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance may apply for other services.
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 by the Aetna Medicare Value Plus (HMO-POS) plan, including Durable Medical Equipment with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance. Diabetic Equipment is also covered, including Diabetic Supplies with a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Aetna Medicare Value Plus (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $5, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, Therapeutic Radiological Services have a copay of $80 or more, and Outpatient X-Ray Services have a $35 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, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific cost is not detailed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value Plus (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, 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. The plan also covers other services like annual wellness exams and screening mammography, and gFOBT and FIT, with no copay.
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