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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 Southwest. 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 you meet your deductible, you will pay the following costs for your prescriptions. For preferred generic drugs, you will have no copay at preferred and mail-order pharmacies, and a $12 copay at standard pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 24% or 25% coinsurance, depending on the tier and pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers comprehensive coverage, with a focus on outpatient services, and includes no copays for many services. This plan covers inpatient hospital stays with a copay, and covers ambulance services with a copay or coinsurance depending on the type of service. This plan also offers coverage for primary care, preventive services, hearing, vision, and dental services, with varying copays or no copays for many services. Other benefits include home health services, skilled nursing facility stays, and medical equipment, with specific copays, coinsurance, or no copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $275 for days 1-6 and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, but 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 all outpatient hospital services, are covered by the Aetna Medicare Value (PPO) plan, with copays ranging from $0 to $275. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $75 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered with a $75 copay. 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 $260 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 and Urgent Coverage, and a $260 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 for routine care, and occupational therapy services with a $30 copay. This plan also covers physician specialist services with a copay between $0 and $35, and mental health, psychiatric, and opioid treatment program services with a $40 copay. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $75. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and additional preventive services. Kidney disease education services have a 20% coinsurance, and other preventive services, including glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, have no copay. Additional services like health education, nutritional/dietary benefits, wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, fitness benefits, and remote access technologies are covered.
Hearing Services See details
Hearing exams have a $35 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per ear per year, while OTC hearing aids are not covered.
Vision Services See details
The Aetna Medicare Value (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with no copay. Eyewear has a combined maximum benefit of $195 per year, covering contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Aetna Medicare Value (PPO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic dental services with no copay, and also covers prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, but does not cover maxillofacial prosthetics, implant services, or orthodontics. Medicare dental services have a $35 copay, and the plan has a $1,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value (PPO) plan, with a coinsurance of 20%. Prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the Aetna Medicare Value (PPO) plan. Durable Medical Equipment (DME) 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 equipment is covered, with coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts and a copay for Medicare-covered Diabetes Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, and Diagnostic Procedures/Tests have a copay between $0 and $75. Lab Services have no copay, while Diagnostic Radiological Services have a copay up to $275. Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Aetna Medicare Value (PPO) covers Cardiac Rehabilitation Services, but 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. There is a copay for covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value (PPO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. 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, 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. Over-the-Counter (OTC) Items and Meal Benefit are covered with no copay. Other services, including annual wellness exams and screening mammography, and gFOBT/FIT, are covered with no copay.
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