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Aetna Medicare Advantra Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Value (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 Advantra Value (HMO-POS) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Value (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 Advantra Value (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 Advantra Value (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 Advantra Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Advantra Value (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 example, preferred generic drugs have no copay at preferred pharmacies and a $12 copay at standard pharmacies, while standard generic drugs have 24% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D costs are $0.
Additional Benefits
The Aetna Medicare Advantra Value (HMO-POS) plan offers a range of benefits with varying costs. You'll find coverage for hospital stays with copays, outpatient services with copays, and ambulance services with copays or coinsurance. Emergency services and primary care have copays, while preventive services like annual exams are covered with no copay. This plan also includes hearing, vision, and dental benefits, often with no copays for routine services, and maximum benefit amounts for hearing aids and dental services. Other benefits include home infusion, dialysis, medical equipment, and home health services with copays or coinsurance, along with coverage for over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Aetna Medicare Advantra Value (HMO-POS) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and outpatient substance abuse services, with copays ranging from $0 to $325. This plan also covers Ambulatory Surgical Center (ASC) services with no copay, and outpatient blood services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $35.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Advantra Value (HMO-POS) plan, with prior authorization required. There is no copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $230 copay, air ambulance services with 20% coinsurance, and transportation services to plan-approved health-related locations, offering 6 one-way trips per year with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $110 copay, and Worldwide Emergency Transportation has a $230 copay.
Primary Care See details
The Aetna Medicare Advantra Value (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $35 copay. Physician Specialist Services have a copay between $10 and $35, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services have a $35 copay for individual and group sessions. Podiatry services and other health care professional services have copays between $35 and $0, respectively. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services have a $35 copay.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay, and other services like Health Education, Nutritional/Dietary Benefit, 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 with no copay. Kidney Disease Education Services are covered with 20% coinsurance. Some services are not covered, including In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aids with no copay. Prescription Hearing Aids are covered up to a maximum of $500 per ear annually, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, as well as OTC Hearing Aids.
Vision Services See details
Vision services include eye exams with a copay of $0-$35, routine eye exams with no copay, and other eye exam services with no copay. Eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered with no copay, and a combined maximum plan benefit coverage of $250 per year.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1500 maximum plan benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Aetna Medicare Advantra Value (HMO-POS) plan. This includes 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.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Value (HMO-POS) plan, but require prior authorization. You will pay a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Aetna Medicare Advantra Value (HMO-POS) plan. Durable Medical Equipment (DME) has a coinsurance of 0% to 20%, and Prosthetic Devices have a coinsurance of 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with a copay of $0, Diagnostic Procedures/Tests with a copay between $0 and $5, and Outpatient X-Ray Services with a $25 copay. Diagnostic Radiological Services have a copay of up to $295, and Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Value (HMO-POS) plan 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 by the Aetna Medicare Advantra Value (HMO-POS) plan, but the specific services are not covered. There is a copay for some of the services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Advantra Value (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Aetna Medicare Advantra Value (HMO-POS) plan covers over-the-counter items with no copay, and a maximum benefit of $45 every three months. This plan also covers meal benefits with no copay, as well as annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, 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, and Self-Directed Personal Assistance Services are not covered.
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