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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 WI Southeast. 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 a $590 deductible for prescription drugs. After the deductible is met, the plan has different cost-sharing amounts depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies and preferred mail order, while standard generic drugs have 24% coinsurance at all pharmacies. For those who qualify for the low-income subsidy (LIS), there is no cost for Part D drugs. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers comprehensive coverage with varying cost-sharing structures. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency services have copays, and ambulance services have copays or coinsurance. The plan includes coverage for primary care, preventive services with no copay, and hearing, vision, and dental services with no copay for many services, but copays for others, and a maximum benefit for eyewear and dental. Home health services, skilled nursing facilities, and home infusion are covered. Additionally, the plan covers a range of other services, including medical equipment, diagnostic services, and cardiac rehabilitation.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For days 1-6, there is a $295 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Value (PPO) plan. Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $295 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a $75 copay for both individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan with a $75 copay, and prior authorization is required.
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 a 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, and Urgently Needed Services have a $45 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125, $125, and $280, respectively.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $40 copay, Physician Specialist Services with a copay between $0 and $40, and Mental Health Specialty Services with a $40 copay. Additionally, Other Health Care Professional services have a copay between $0 and $40, Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $75. Opioid Treatment Program Services have a $40 copay. However, Podiatry Services are not covered, and Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services like health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies, all with no copay. Kidney disease education services have a 20% coinsurance. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit, all with no copay.
Hearing Services See details
The Aetna Medicare Value (PPO) plan covers hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to $750 per ear annually, with two visits per year with no copay for prescription hearing aids (all types). Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay between $0 and $40, while routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades have no copay. There is a combined maximum benefit of $185 per year for eyewear.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay, and a maximum benefit of $1800 per year. Restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 0% to 20% coinsurance. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay; Diagnostic Radiological Services have a copay up to $200. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Value (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Aetna Medicare Value (PPO) plan, but the plan does not cover the specific services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the specific copay amount is not provided.
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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Aetna Medicare Value (PPO) plan, Over-the-Counter (OTC) Items and Meal Benefits are covered with no copay, and Other 1 and Other 2 are covered 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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