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Aetna Medicare Advantra Value (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Advantra Value (HMO). 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) in 2025, please refer to our full plan details page.
Aetna Medicare Advantra Value (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Kent, New Castle, Sussex counties. 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) 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).
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), 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. Additionally, this plan comes with a Part B Premium reduction of $8.00. You must continue to pay paying your reduced 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 $250.00 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 $5900.00 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:
Sign up for Aetna Medicare Advantra Value (HMO)
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Drug Coverage
The Aetna Medicare Advantra Value (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you pay a $10 copay at a preferred pharmacy or $12 at a standard pharmacy. For standard generic drugs, you pay 25% coinsurance. For preferred brand drugs, you pay 26% coinsurance, and for non-preferred drugs, you pay 30% coinsurance.
Additional Benefits
The Aetna Medicare Advantra Value (HMO) plan offers a range of benefits with varying costs. The plan covers inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $275, as well as no copays for many preventive services. The plan also includes coverage for hearing, vision, and dental services, along with other services such as ambulance, emergency, and home health services.
Inpatient Hospital See details
The Aetna Medicare Advantra Value (HMO) plan covers inpatient hospital stays, with a copay of $300 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $350 for days 1-5 and no copay for days 6-90 for psychiatric care; non-Medicare covered stays and upgrades are not covered. Additional days for inpatient hospital-acute are covered with no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0-$275, Observation Services have a copay of $275, Ambulatory Surgical Center Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Advantra Value (HMO) plan, with no copay required. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $265 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, with 6 one-way trips per year and no copay. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Advantra Value (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay, and Worldwide Emergency Transportation has a $265 copay.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, Podiatry Services, and Opioid Treatment Program Services all have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Other Health Care Professional services have a copay between $0-$30. Additional Telehealth benefits have a 20% coinsurance and a copay between $0-$50. Physician Specialist Services are covered with a copay between $0-$30.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Additional preventive services, including health education, nutritional/dietary benefits, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit are covered with no copay. Kidney disease education services are covered with 20% coinsurance. 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 are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $500 per year, and have a $0 copay, but specific types of prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Advantra Value (HMO) plan covers vision services, including eye exams with a copay of $0-$30, and routine eye exams and other eye exam services with no copay. Eyewear is also covered, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay, up to a combined maximum of $275 per year.
Dental Services See details
Dental services are covered, with a $30 copay for Medicare Dental Services. Other dental services include 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, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $1,500 maximum plan benefit coverage every year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Advantra Value (HMO) plan. This plan requires prior authorization, and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with a coinsurance between 0% and 20%, and prosthetic devices and medical supplies with a coinsurance of 20%. Diabetic equipment, including supplies, has a coinsurance between 0% and 20% and diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $225, Therapeutic Radiological Services have a copay of up to $80, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Advantra Value (HMO) 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, but none of the listed sub-services are covered. There is a copay for covered services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Advantra Value (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Advantra Value (HMO) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit of $90 every three months, and offers nicotine replacement therapy and Naloxone. The plan does not cover 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, 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. The plan also covers meal benefits and other services with no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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