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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 Kern, Riverside and San Bernardino Counties. This plan received an overall rating of 2.5 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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $27.60. 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 $450.00 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 $599.00 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 $450 deductible. In the initial coverage phase, you will pay a $0 copay for preferred generic drugs at preferred pharmacies and preferred mail order, and a $12 copay at standard pharmacies and standard mail order. For standard generic drugs, you will pay 22% coinsurance, and for preferred brand drugs, you will pay 25% coinsurance. For non-preferred drugs, you will pay 27% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase. During the catastrophic coverage phase, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO-POS) plan offers comprehensive coverage with a focus on outpatient services, preventive care, and dental services. Many services, including inpatient hospital stays, outpatient services, primary care, preventive services, and dental services, have no copay. The plan also offers coverage for hearing exams, prescription hearing aids, and a wide range of diagnostic and radiological services, often with no copay. This plan also covers ambulance and transportation services, with varying copays and coinsurance depending on the type of service. Emergency services are covered with a $140 copay, while home health services and skilled nursing facilities have different cost structures. The plan has a maximum benefit coverage of $3,000 per year for dental services.
Inpatient Hospital See details
Inpatient Hospital benefits with the Aetna Medicare Value Plus (HMO-POS) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for Medicare-covered stays; additional days for Inpatient Hospital-Acute are also covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services have no copay, while outpatient substance abuse services have no copay for individual and group sessions.
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 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered, with no copay, up to 12 one-way trips per year, and transportation includes rideshare services, bus/subway, and medical transport; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered by the Aetna Medicare Value Plus (HMO-POS) plan. Emergency Services have a $140 copay and no coinsurance, while urgently needed services have no copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and Worldwide Emergency Transportation has a $275 copay, with no coinsurance for any of these services.
Primary Care See details
The Aetna Medicare Value Plus (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay for most services. Additional telehealth benefits have a 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with varying copays depending on the service. Kidney Disease Education Services are covered with 20% coinsurance. Other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered up to a maximum of $1250 per ear every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams, including routine eye exams and other eye exam services, have no copay. Eyewear is not covered by this plan.
Dental Services See details
Dental services are covered, 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, all with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has a maximum benefit coverage of $3,000 per year.
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 with prior authorization. Insulin has a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
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 is covered by the Aetna Medicare Value Plus (HMO-POS) plan, with Durable Medical Equipment (DME) subject to a coinsurance between 0% and 20%, and no copay. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have no coinsurance. 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 are covered under the Aetna Medicare Value Plus (HMO-POS) plan. Diagnostic Procedures/Tests have no copay, Lab Services have no copay, Diagnostic Radiological Services have no copay, and Outpatient X-Ray Services have no copay, while Therapeutic Radiological Services have a $60 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $50. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture with no copay, while over-the-counter items, meal benefits, and several other services are not covered. Other services include annual wellness exams and screening mammography with no copay, and gFOBT and FIT with no copay.
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