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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 Northern Rural Utah and Southwest Wyoming. 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 $51.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $11300.00 (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 $11300.00 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, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay at preferred pharmacies and mail order, but a $12 copay at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a wide range of benefits with varying cost-sharing. You'll find no copay for many services, including primary care, preventive services like annual exams, hearing exams, vision exams, eyewear, and dental services like oral exams and cleanings. The plan also covers inpatient hospital stays, outpatient services, partial hospitalization, ambulance services, emergency services, and more, with specific copays or coinsurance amounts depending on the service.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $400 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric services have a $370 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 stays and upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
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 between $0 and $400, while observation services have a $400 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan. This benefit has a $55 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 $300 copay, and Air Ambulance Services have a 20% coinsurance. Transportation Services to health-related locations 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 and Worldwide Emergency Coverage each have a $110 copay, Worldwide Emergency Transportation has a $300 copay, and Urgently Needed Services has a $45 copay.
Primary Care See details
The Aetna Medicare Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, and physician specialist services with a copay between $0 and $45. Mental health and psychiatric services, opioid treatment, and telehealth services each have a $40 copay for individual and group sessions. Additionally, the plan covers physical therapy and speech-language pathology services for a $35 copay.
Preventive Services See details
The Aetna Medicare Value (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay. Other preventive services like 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 have a 20% coinsurance.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, each of which are limited to one visit per year. Prescription hearing aids have a maximum benefit of $1,000 per ear every year, with no copay for all types of prescription hearing aids (all types). OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (PPO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and you are eligible for one routine eye exam per year. Eyewear has a combined maximum benefit of $100 per year for both in and out-of-network services.
Dental Services See details
Dental services are covered, with a $1,000 annual maximum benefit. Medicare dental services have a $45 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, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by the Aetna Medicare Value (PPO) plan. 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. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies, with a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment includes coverage for Diabetic Supplies with a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $10, and lab services with no copay. Radiological services are also covered, with a copay up to $295 for diagnostic services, a coinsurance of at least 20% for therapeutic services, and no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by Aetna Medicare Value (PPO) 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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some services, but the specific amount is not detailed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203.00. 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, Other Services include Over-the-Counter (OTC) Items, with a $0 copay, and Other 1 and Other 2 services, both with a $0 copay. Acupuncture, Meal Benefit, 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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