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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 IN Northeast. 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 $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 combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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 an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you pay the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy used. Preferred Generic drugs have no copay at preferred pharmacies and mail order, but have a $12 copay at standard pharmacies. Coinsurance amounts vary from 24% to 25% depending on the drug tier. Once your total drug costs reach $2000.00, you will enter the next coverage phase.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $275 copay for days 1-7, and no copay for days 8-90. Outpatient services have copays between $0 and $325, and emergency services have a $125 copay. The plan provides coverage for primary care with no copay, and specialist visits with a copay between $0 and $35. Preventive services, including annual exams, are covered with no copay. The plan also offers hearing, vision, and dental benefits, as well as home health services with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you also pay a $275 copay for days 1-7, and no copay for days 8-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services with a copay between $0 and $325, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $75 copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan, and requires prior authorization. You will have a $75 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground ambulance services have a $280 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $280 copay for Worldwide Emergency Transportation.
Primary Care See details
The Aetna Medicare Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $35, and physical therapy and speech-language pathology services with a $30 copay. The plan also covers mental health and psychiatric services with a $40 copay, other health care professional services with a copay between $0 and $35, additional telehealth benefits with a 20% coinsurance and a copay between $0 and $75, and opioid treatment program services with a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include annual physical exams with no copay, and additional preventive services. The plan covers Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing services include hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $500 per ear annually, and all types of prescription hearing aids are covered with no copay, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (PPO) plan covers vision services, including eye exams with a copay ranging from $0 to $35. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades with no copay, and a combined maximum plan benefit coverage of $150 per year for both in-network and out-of-network services.
Dental Services See details
Aetna Medicare Value (PPO) offers dental services with a $1,450 annual maximum benefit. Medicare dental services have a $35 copay, 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have 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 under the Aetna Medicare Value (PPO) plan, with prior authorization required. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance, and Diabetic Equipment with a coinsurance and copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Outpatient X-Ray Services have a $20 copay, while Diagnostic Radiological Services have a copay up to $250 and Therapeutic Radiological Services have 20% coinsurance.
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, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The copay for covered services is listed in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Under the "Other Services" benefit, acupuncture, Dual Eligible SNPs, 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. Over-the-counter (OTC) items and Meal Benefit have no copay. Annual wellness exams, screening mammography, gFOBT, and FIT have no copay.
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