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Aetna Medicare Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Value (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Cleveland and Toledo Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value (PPO) 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 (PPO).
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 (PPO), 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 $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 combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 (PPO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $10 copay at preferred pharmacies and a $12 copay at standard pharmacies. For standard generic drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers comprehensive coverage for a variety of healthcare services. This plan includes coverage for inpatient and outpatient hospital services, with varying copays depending on the service. You'll also find coverage for primary care, specialist visits, mental health, and therapy services, with copays ranging from $5 to $40. Additional benefits include preventive services with no copay for many services, along with coverage for hearing, vision, and dental services. The plan also covers ambulance and transportation services, emergency services, and home health services. This plan provides coverage for a wide range of needs, with a focus on keeping costs manageable through copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with 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, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric benefits are covered with a $350 copay for days 1-5, and no copay for days 6-90; however, Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the Aetna Medicare Value (PPO) plan include outpatient hospital services with a copay between $0 and $400, observation services with a $350 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground and Air Ambulance Services have a $270 copay, and Transportation Services to a plan-approved health-related location have 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 under the Aetna Medicare Value (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Services have varying copays depending on the specific service: $125 for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and $270 for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Value (PPO) plan covers primary care physician services with a $5 copay. Chiropractic services have a $20 copay, while occupational therapy services have a $40 copay. For physician specialist services, the copay ranges from $0 to $40. Mental health and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Additional telehealth benefits have a 20% coinsurance and a copay ranging from $0 to $45. Opioid treatment program services have a $40 copay. Podiatry services and other health care professional services have a copay, as well. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services are covered with a copay; other covered services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance, and other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing services with the Aetna Medicare Value (PPO) plan include hearing exams with a $40 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a maximum benefit of $1500 per year. 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, including eye exams and eyewear, are covered. Eye exams have a copay of $0 to $40, and eyewear has a combined maximum plan benefit of $205 per year with no copay.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers Medicare Dental Services with no copay, and other dental services including oral exams, dental x-rays, and teeth cleanings with no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are covered with coinsurance between 20% and 50%.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. 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 under the Aetna Medicare Value (PPO) plan, but require prior authorization. You are responsible for a 20% coinsurance.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), prosthetics, and medical supplies, is covered. DME has a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Diabetic supplies and Diabetic Therapeutic Shoes/Inserts are covered, with Diabetic Supplies having a coinsurance of 0% to 20% and Diabetic Therapeutic Shoes/Inserts having no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered by the Aetna Medicare Value (PPO) plan, with copays ranging from $0 to $150 for Diagnostic Procedures/Tests and no copay for Lab Services. The plan also covers Diagnostic and Therapeutic Radiological Services, with a copay up to $235 for Diagnostic Radiological Services, and a coinsurance of at least 20% for Therapeutic Radiological Services, as well as a $5 copay for Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (PPO) 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 Value (PPO) plan, but the specific sub-services are not covered. The plan does not specify the cost sharing for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Aetna Medicare Value (PPO) plan covers over-the-counter (OTC) items and meal benefits with no copay. Acupuncture and several other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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