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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 MI 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 $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 $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For preferred generic drugs, you pay no copay at preferred pharmacies and mail order, but $12 at standard pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 24% or 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value (PPO) plan offers a wide array of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, as well as outpatient services, emergency services, and primary care with copays ranging from $0 to $255. Preventive, hearing, vision, and dental services are also covered, with specific copays and maximum benefits for certain services. Additional benefits include home health services with no copay, and coverage for durable medical equipment, dialysis, and home infusion with coinsurance. The plan also covers skilled nursing facility stays with a copay, and offers other services like over-the-counter items and meal benefits with no copay. However, some services like podiatry, maxillofacial prosthetics, and orthodontics are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $285 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $285 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 are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Aetna Medicare Value (PPO) plan. Outpatient Hospital Services have a copay between $0 and $250, Observation Services have a $250 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $75, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Value (PPO) plan, but requires prior authorization. For this benefit, there is a $75 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground ambulance services have a $255 copay, while air ambulance services have a 20% coinsurance; however, 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 under the Aetna Medicare Value (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Transportation has a $255 copay. Worldwide Emergency Services also has a maximum plan benefit coverage of $100,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay (routine care is not covered), Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $0-$35 copay, Mental Health Specialty Services with a $40 copay for individual or group sessions, Other Health Care Professional services with a $0-$35 copay, Psychiatric Services with a $40 copay for individual or group sessions, Physical Therapy and Speech-Language Pathology Services with a $30 copay, and Opioid Treatment Program Services with a $40 copay. Additional Telehealth Benefits are covered with a 20% coinsurance and a $0-$75 copay. Podiatry Services are not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, as well as additional preventive services, some of which have a copay. Kidney disease education services have a 20% coinsurance, and other preventive services have no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, Routine Hearing Exams with no copay for 1 visit every year, and Fitting/Evaluation for Hearing Aid with no copay for 1 visit every year. Prescription Hearing Aids are covered with a maximum benefit of $1000.00 per ear every year, and Prescription Hearing Aids (all types) are covered with no copay for 2 visits every year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a copay of $0-$35, while eyewear has a combined maximum of $275 per year with no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered, with a $35 copay for Medicare dental services and a $2,200 annual maximum for other dental services. 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, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Value (PPO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a coinsurance between 0% and 20%, while Prosthetic Devices have a 20% coinsurance and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $275, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.
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 plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under 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
Under the Aetna Medicare Value (PPO) plan, Other Services includes Over-the-Counter (OTC) Items with no copay, a maximum benefit coverage amount of $75 every three months, and also covers meal benefits 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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